Anthony David, George Paul, Eaton Charles B
Memorial Hospital of Rhode Island, 111 Brewster St., Pawtucket, RI 02903, USA.
Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA.
FP Essent. 2014 Jun;421:28-43.
The 2013 American College of Cardiology/American Heart Association cholesterol guidelines depart from low-density lipoprotein (LDL) treatment targets and recommend treating four specific patient groups with statins. Statins are the only cholesterol-lowering drugs with randomized trial evidence of benefit for preventing atherosclerotic cardiovascular disease (ASCVD). The groups are patients with clinical ASCVD; patients ages 40 to 75 years with diabetes and LDL of 70 to 189 mg/dL but no clinical ASCVD; patients 21 years or older with LDL levels of 190 mg/dL or higher; and patients ages 40 to 75 years with LDL of 70 to 189 mg/dL without clinical ASCVD or diabetes but with 10-year ASCVD risk of 7.5% or higher. Ten-year ASCVD risk may be calculated using the Pooled Cohort Equations. The Eighth Joint National Committee (JNC 8) guidelines for blood pressure management recommend a blood pressure goal of less than 140/90 mm Hg for all adults except those 60 years or older. For the latter group, the JNC 8 recommends a systolic blood pressure goal of less than 150 mm Hg. In another notable change from prior guidelines, the JNC 8 recommends relaxing the systolic blood pressure goal for patients with diabetes and chronic kidney disease to less than 140 mm Hg from less than 130 mm Hg.
2013年美国心脏病学会/美国心脏协会胆固醇指南背离了低密度脂蛋白（LDL）治疗目标，建议使用他汀类药物治疗四个特定患者群体。他汀类药物是唯一有随机试验证据表明对预防动脉粥样硬化性心血管疾病（ASCVD）有益的降胆固醇药物。这些群体包括患有临床ASCVD的患者；年龄在40至75岁、患有糖尿病且LDL为70至189mg/dL但无临床ASCVD的患者；21岁及以上、LDL水平为190mg/dL或更高的患者；以及年龄在40至75岁、LDL为70至189mg/dL、无临床ASCVD或糖尿病但10年ASCVD风险为7.5%或更高的患者。10年ASCVD风险可使用合并队列方程计算。美国国家联合委员会第八次报告（JNC 8）的血压管理指南建议，除60岁及以上成年人外，所有成年人的血压目标应低于140/90mmHg。对于后一组人群，JNC 8建议收缩压目标低于150mmHg。与先前指南的另一个显著变化是，JNC 8建议将糖尿病和慢性肾病患者的收缩压目标从低于130mmHg放宽至低于140mmHg。
