Cohen Jerome D
Saint Louis University School of Medicine, 8138 Westmoreland Ave, St Louis, MO 63105-3731, USA.
J Am Osteopath Assoc. 2011 Apr;111(4 Suppl 3):eS7-12.
According to current guidelines from the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), the target low-density lipoprotein cholesterol (LDL-C) level for patients with established coronary heart disease (CHD) or CHD risk equivalents is less than 100 mg/dL, with an optional target of less than 70 mg/dL. More recent data suggest, however, that the physiologically normal level of LDL-C and the level at which atherogenesis is initiated is much lower. Overall, the data convincingly demonstrate that LDL-C lowering is associated with a significant reduction in CHD events, regardless of preexisting CHD. The NCEP ATP III treatment guidelines, published in 2002 and updated in 2004, do not reflect more recent findings on intensive lipid-lowering therapy, which are likely be addressed in the NCEP ATP IV guidelines, scheduled to be released in 2011. Drug options for LDL-C lowering include statins (the drug of choice), bile acid sequestrants, nicotinic acid, fibrates, and selective cholesterol absorption inhibitors.
根据美国国家胆固醇教育计划成人治疗小组第三次报告（NCEP ATP III）的现行指南，已确诊冠心病（CHD）或具有CHD风险等同情况的患者，其低密度脂蛋白胆固醇（LDL-C）的目标水平应低于100mg/dL，可选择的目标是低于70mg/dL。然而，最近的数据表明，LDL-C的生理正常水平以及动脉粥样硬化起始时的水平要低得多。总体而言，数据令人信服地表明，降低LDL-C与显著减少CHD事件相关，无论患者是否已患有CHD。2002年发布并于2004年更新的NCEP ATP III治疗指南并未反映出强化降脂治疗的最新研究结果，这些结果可能会在计划于2011年发布的NCEP ATP IV指南中得到阐述。降低LDL-C的药物选择包括他汀类药物（首选药物）、胆汁酸螯合剂、烟酸、贝特类药物和选择性胆固醇吸收抑制剂。
