Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Methodist DeBakey Heart and Vascular Center, 6565 Fannin, M.S. A-601, Houston, TX 77030, USA.
Nat Rev Cardiol. 2011 May;8(5):253-65. doi: 10.1038/nrcardio.2011.2. Epub 2011 Feb 15.
A continuous, graded relationship exists between LDL cholesterol (LDL-C) levels and risk of cardiovascular disease (CVD). This finding has been confirmed at progressively lower levels of LDL-C by results from clinical trials of therapies, particularly high-potency statins, which provide increasingly greater reductions in LDL-C levels. On the basis of this clinical trial evidence, progressively lower LDL-C goals for increasing numbers of patients, stratified by absolute CVD risk, have been recommended in guidelines for cholesterol management and CVD prevention. Some notable exceptions have been made, however, such as patients with end-stage renal disease or heart failure. To achieve low LDL-C goals, statins are first-line pharmacological therapy and can be combined with other agents to provide additional reductions in LDL-C levels as well as improvements in other lipoprotein fractions. Investigational agents that reduce LDL-C levels by other mechanisms are under development and could provide additional therapeutic strategies to achieve optimal LDL-C levels. These agents could be particularly appropriate for patients with severely elevated LDL-C levels, such as those with genetic dyslipidemia, for whom maximal drug therapy is insufficient to reduce LDL-C concentrations to recommended levels.
LDL 胆固醇（LDL-C）水平与心血管疾病（CVD）风险之间存在连续的、分级的关系。这一发现已通过治疗的临床试验结果得到证实，特别是高效力他汀类药物，它们能使 LDL-C 水平降低得越来越多。基于这些临床试验证据，指南建议根据绝对 CVD 风险对越来越多的患者设定 LDL-C 水平逐渐降低的目标，以进行胆固醇管理和 CVD 预防。然而，也有一些显著的例外情况，如终末期肾病或心力衰竭的患者。为了达到低 LDL-C 目标，他汀类药物是一线药物治疗方法，并且可以与其他药物联合使用，以进一步降低 LDL-C 水平，并改善其他脂蛋白部分。正在开发通过其他机制降低 LDL-C 水平的研究药物，可为实现最佳 LDL-C 水平提供额外的治疗策略。对于 LDL-C 水平严重升高的患者，这些药物可能特别合适，如那些具有遗传血脂异常的患者，对于这些患者，最大药物治疗不足以将 LDL-C 浓度降低至推荐水平。
