Department of Medicine, Division of Cardiology, New York Medical College/Westchester Medical Center, Valhalla, NY 10595, USA.
Cardiol Rev. 2010 May-Jun;18(3):132-40. doi: 10.1097/CRD.0b013e3181c29571.
Multiple randomized, double-blind, placebo-controlled studies and observational studies have demonstrated that statins decrease mortality and major cardiovascular events in high-risk persons with hypercholesterolemia. The Heart Protection Study showed that statins decreased mortality and major cardiovascular events in high-risk persons regardless of the initial level of serum lipids, age, or gender. The updated National Cholesterol Education Program III guidelines state that in very high-risk patients, a serum low-density lipoprotein (LDL) cholesterol level of <70 mg/dL is a reasonable clinical strategy, regardless of age. When a high-risk person has hypertriglyceridemia or low serum high-density lipoprotein cholesterol, consideration can be given to combining a fibrate or nicotinic acid with an LDL cholesterol-lowering drug. For moderately high-risk persons, the serum LDL cholesterol should be lowered to <100 mg/dL. When LDL cholesterol-lowering drug therapy is used to treat high-risk persons or moderately high-risk persons, the serum LDL cholesterol should be reduced at least 30% to 40%. High-risk older persons should be treated with lipid-lowering drug therapy according to National Cholesterol Education Program III updated guidelines to decrease cardiovascular morbidity and mortality. The LDL cholesterol should be decreased to <160 mg/dL in persons at low risk for cardiovascular disease.
多项随机、双盲、安慰剂对照研究和观察性研究表明，他汀类药物可降低高胆固醇血症高危人群的死亡率和主要心血管事件。心脏保护研究表明，他汀类药物可降低高危人群的死亡率和主要心血管事件，无论其血脂初始水平、年龄或性别如何。更新的国家胆固醇教育计划 III 指南指出，在极高危患者中，血清低密度脂蛋白（LDL）胆固醇水平<70mg/dL 是一种合理的临床策略，无论年龄如何。当高危患者存在高三酰甘油血症或低血清高密度脂蛋白胆固醇时，可以考虑将纤维酸或烟酸与 LDL 胆固醇降低药物联合使用。对于中度高危人群，血清 LDL 胆固醇应降至<100mg/dL。当使用 LDL 胆固醇降低药物治疗高危或中度高危人群时，血清 LDL 胆固醇应降低至少 30%至 40%。根据国家胆固醇教育计划 III 更新指南，高危老年人应进行降脂药物治疗，以降低心血管发病率和死亡率。对于患心血管疾病风险较低的人，LDL 胆固醇应降至<160mg/dL。
