University of Chicago Pritzker School of Medicine, Chicago, IL 60610, USA.
J Clin Lipidol. 2011 Sep-Oct;5(5):338-67. doi: 10.1016/j.jacl.2011.07.005.
The National Cholesterol Education Program Adult Treatment Panel guidelines have established low-density lipoprotein cholesterol (LDL-C) treatment goals, and secondary non-high-density lipoprotein (HDL)-C treatment goals for persons with hypertriglyceridemia. The use of lipid-lowering therapies, particularly statins, to achieve these goals has reduced cardiovascular disease (CVD) morbidity and mortality; however, significant residual risk for events remains. This, combined with the rising prevalence of obesity, which has shifted the risk profile of the population toward patients in whom LDL-C is less predictive of CVD events (metabolic syndrome, low HDL-C, elevated triglycerides), has increased interest in the clinical use of inflammatory and lipid biomarker assessments. Furthermore, the cost effectiveness of pharmacological intervention for both the initiation of therapy and the intensification of therapy has been enhanced by the availability of a variety of generic statins. This report describes the consensus view of an expert panel convened by the National Lipid Association to evaluate the use of selected biomarkers [C-reactive protein, lipoprotein-associated phospholipase A(2), apolipoprotein B, LDL particle concentration, lipoprotein(a), and LDL and HDL subfractions] to improve risk assessment, or to adjust therapy. These panel recommendations are intended to provide practical advice to clinicians who wrestle with the challenges of identifying the patients who are most likely to benefit from therapy, or intensification of therapy, to provide the optimum protection from CV risk.
美国国家胆固醇教育计划成人治疗专家组指南已经为高甘油三酯血症患者确立了低密度脂蛋白胆固醇（LDL-C）治疗目标和次要的非高密度脂蛋白（HDL）-C 治疗目标。使用降脂治疗，特别是他汀类药物，来实现这些目标已经降低了心血管疾病（CVD）的发病率和死亡率；然而，仍然存在显著的残留风险。再加上肥胖症的患病率不断上升，这种情况改变了人群的风险状况，使 LDL-C 对 CVD 事件的预测性降低的患者（代谢综合征、低 HDL-C、高甘油三酯）比例增加，这使得人们对炎症和脂质生物标志物评估的临床应用产生了浓厚的兴趣。此外，由于各种通用他汀类药物的出现，药物干预的起始和强化治疗的成本效益也得到了提高。本报告描述了由国家脂质协会召集的一个专家小组的共识意见，以评估使用选定的生物标志物[C 反应蛋白、脂蛋白相关磷脂酶 A(2)、载脂蛋白 B、LDL 颗粒浓度、脂蛋白(a)以及 LDL 和 HDL 亚组分]来改善风险评估或调整治疗的方法。这些小组建议旨在为那些在确定最有可能从治疗或强化治疗中获益的患者方面存在困难的临床医生提供实用建议，以提供最佳的心血管风险保护。
