Parhofer K G
Medizinische Klinik und Poliklinik II, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
Internist (Berl). 2013 Sep;54(9):1089-103. doi: 10.1007/s00108-013-3335-3.
The treatment of dyslipidemia is a cornerstone of atherosclerosis prevention. Statin-based reduction of LDL cholesterol plays a central role in this context. Whether and to what extent other lipids such as triglycerides, HDL-cholesterol, lipoprotein(a) should also be addressed is still under discussion. However, in the treatment of hypertriglyceridemia and combined hyperlipoproteinemia, life-style modification plays a significant role. Important issues are correct classification of the dyslipidemia, a LDL-cholesterol target based on the absolute risk of the patient, and a therapeutic strategy that also includes treatment of other risk factors. If statin therapy not sufficient to reach the treatment target, combination therapy with ezetimibe, bile acid binding substances, fibrates or ω-3 fatty acids should be discussed, considering the lipid profile, the overall risk, and potential side effects. Patients with severe LDL hypercholesterolemia or greatly elevated lipoprotein(a) levels should be considered for regular lipid apheresis if the cardiovascular disease is progressing.
血脂异常的治疗是动脉粥样硬化预防的基石。在此背景下,基于他汀类药物降低低密度脂蛋白胆固醇起着核心作用。其他脂质如甘油三酯、高密度脂蛋白胆固醇、脂蛋白(a)是否以及在何种程度上也应得到关注仍在讨论中。然而,在治疗高甘油三酯血症和混合型高脂血症时,生活方式的改变起着重要作用。重要的问题包括血脂异常的正确分类、基于患者绝对风险的低密度脂蛋白胆固醇目标,以及还包括治疗其他危险因素的治疗策略。如果他汀类药物治疗不足以达到治疗目标,则应考虑联合依折麦布、胆汁酸结合剂、贝特类药物或ω-3脂肪酸进行治疗,同时考虑血脂谱、总体风险和潜在副作用。如果心血管疾病进展,对于严重的低密度脂蛋白高胆固醇血症或脂蛋白(a)水平大幅升高的患者,应考虑定期进行血脂分离治疗。