Lew Kelley Newlin, Kent Daniel J, Muñoz Angelica A, Melkus Gail D'Eramo
School of Nursing, University of Connecticut, Storrs, Connecticut.
J Am Assoc Nurse Pract. 2013 Sep;25(9):488-94. doi: 10.1002/2327-6924.12053.
The majority of patients with type 2 diabetes mellitus (T2DM) have multiple risk factors for cardiovascular disease (CVD). Low-density lipoprotein cholesterol (LDL-C) is a key therapeutic target to reduce CVD risk. This article reviews therapeutic strategies that nurse practitioners (NPs) may use in the management of patients with T2DM requiring lipid management.
The evidence used in developing this review included evidence-based reviews, clinical trials, guidelines, and consensus statements. Relevant publications were identified through a search of the literature using PubMed and other search engines.
Lowering LDL-C levels may reduce CVD risk, but achieving goals can be challenging. Lifestyle modifications (including diet, exercise, and smoking cessation) are key components of lipid management and reduction of CVD risk. Statins can be effective to reduce lipids. However, patients may not achieve lipid goals with monotherapy or may experience intolerable adverse effects. Alternative statins or statins along with other lipid-lowering agents remain good options.
Achieving LDL-C goals requires a comprehensive treatment plan that incorporates lifestyle and pharmacologic interventions. Patient commitment in setting goals and self-management is essential. NPs can play an important role in educating patients as well as prescribing appropriate treatments.
大多数2型糖尿病（T2DM）患者存在多种心血管疾病（CVD）风险因素。低密度脂蛋白胆固醇（LDL-C）是降低CVD风险的关键治疗靶点。本文综述了执业护士（NP）在管理需要进行血脂管理的T2DM患者时可能采用的治疗策略。
本综述所使用的证据包括循证综述、临床试验、指南和共识声明。通过使用PubMed和其他搜索引擎检索文献来识别相关出版物。
降低LDL-C水平可能会降低CVD风险，但实现目标可能具有挑战性。生活方式的改变（包括饮食、运动和戒烟）是血脂管理和降低CVD风险的关键组成部分。他汀类药物可有效降低血脂。然而，患者单药治疗可能无法达到血脂目标，或者可能会出现难以耐受的不良反应。换用其他他汀类药物或他汀类药物与其他降脂药物联合使用仍是不错的选择。
实现LDL-C目标需要一个综合的治疗计划，包括生活方式和药物干预。患者在设定目标和自我管理方面的投入至关重要。NP在教育患者以及开具适当治疗方案方面可以发挥重要作用。
