Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY 40536, USA.
Angiology. 2013 Aug;64(6):411-6. doi: 10.1177/0003319712451115. Epub 2012 Jun 25.
The clinical importance of lowering of total cholesterol and low-density lipoprotein cholesterol (LDL-C) to decrease cardiovascular (CV) risk has been verified over many years starting with significant support in 1984 of the then previous lipid hypothesis. Significant support of this hypothesis began that year with publication of the Lipid Research Clinic study. Since then, multiple other studies including outcomes studies have established the value of LDL-C reduction in decreasing CV risk. In addition, multiple other factors such as inflammation, endothelial dysfunction, nitric oxide, antioxidant properties, and plaque stabilization appear important for modifying CV risk and possible favorable alterations by medications such as statins must be considered. Nevertheless, reduction of LDL-C has well-established value and is being accepted by clinicians as a major guideline for CV disease prevention. However, there are still problems with adherence by many clinicians to CV risk modification. Therefore, abandoning LDL-C reduction as a target, as has been advocated by some, appears premature and contraindicated. A strategy of LDL-C reduction in no way interferes with increased understanding of the complexities of atherosclerosis and new approaches to CV disease prevention as they become supported by outcomes studies.
多年来，降低总胆固醇和低密度脂蛋白胆固醇（LDL-C）以降低心血管（CV）风险的临床重要性已经得到了验证，这一假说最早在 1984 年得到了当时前一个脂质假说的重要支持。这一假说的重要支持始于当年发表的脂质研究诊所研究。从那时起，包括结局研究在内的多项其他研究已经证实了 LDL-C 降低对降低 CV 风险的价值。此外，其他多种因素，如炎症、内皮功能障碍、一氧化氮、抗氧化特性和斑块稳定，似乎对改变 CV 风险和可能通过药物（如他汀类药物）产生有利改变很重要。然而，降低 LDL-C 的价值已经得到了很好的证实，并且被临床医生作为 CV 疾病预防的主要指南接受。然而，许多临床医生在 CV 风险修正方面的依从性仍然存在问题。因此，像一些人所主张的那样，放弃 LDL-C 降低作为目标似乎还为时过早，并且是不合适的。降低 LDL-C 的策略绝不会干扰对动脉粥样硬化复杂性的深入了解，也不会干扰新的 CV 疾病预防方法，因为这些方法已经得到了结局研究的支持。
