The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
J Cardiovasc Nurs. 2009 Nov-Dec;24(6):429-38. doi: 10.1097/JCN.0b013e3181b4bab4.
Current clinical guidelines for management of low-density lipoprotein cholesterol (LDL-C) have evolved to reflect the findings of numerous randomized clinical trials and represent an important opportunity to effectively improve the cardiovascular (CV) risk profile of a wide range of patients. Implementation of guideline-recommended LDL-C management strategies facilitates the appropriate use of all available treatments, including lifestyle and dietary changes and pharmacotherapy. Where intensive lowering of LDL-C is required, suboptimal use of statins is a major contributor to the significant number of patients who remain at an unnecessarily increased risk of CV disease as a consequence of failing to reach their guideline-recommended LDL-C goals. This underuse may be explained by concerns over the safety and efficacy of high-dose statin regimens in certain populations. These issues are explored in the context of current, evidence-based clinical guidelines for LDL-C management and, through 3 hypothetical case studies, selection of appropriate starting doses of statins, and titration to a higher dose or switching to a more potent statin, to ensure that patients reach their individual LDL-C goals and reduce their overall CV risk, is also examined.
目前，低密度脂蛋白胆固醇（LDL-C）管理的临床指南已经发展演变，以反映大量随机临床试验的结果，这为有效改善广泛患者的心血管（CV）风险状况提供了重要机会。指南推荐的 LDL-C 管理策略的实施有助于合理利用所有可用的治疗方法，包括生活方式和饮食改变以及药物治疗。在需要降低 LDL-C 的情况下，他汀类药物的使用不理想是导致大量患者仍然面临不必要的 CV 疾病风险增加的主要原因，因为他们未能达到指南推荐的 LDL-C 目标。这种使用不足可能是由于对某些人群中高剂量他汀类药物方案的安全性和疗效的担忧所致。这些问题在当前 LDL-C 管理的循证临床指南的背景下进行了探讨，并通过 3 个假设性病例研究，考察了适当起始他汀类药物剂量的选择，以及滴定至更高剂量或换用更强效的他汀类药物，以确保患者达到其个体 LDL-C 目标并降低其整体 CV 风险。
