Finkel Jonathan B, Duffy Danielle
Thomas Jefferson University Hospital, Philadelphia, PA.
Division of Cardiology, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Mezzanine, Philadelphia, PA.
Trends Cardiovasc Med. 2015 May;25(4):340-7. doi: 10.1016/j.tcm.2014.10.015. Epub 2014 Oct 28.
The 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults represents a major shift from prior cholesterol management guidelines. The new guidelines include data from individual randomized trials as well as the most comprehensive meta-analyses, and introduce several major paradigm shifts, which include: aiming for ASCVD risk reduction as opposed to targeting LDL-C levels, advocating for the use of evidence-based doses of statins as first line therapy, and utilizing a new risk calculator and risk cut point to guide initiation of statin therapy. These major changes have created controversy and confusion among the medical community, with some clinicians hesitant to embrace the shift. We review the evidence that forms the basis for these major changes, compare them to other major lipid guidelines, and recommend an integrated approach to managing dyslipidemia to decrease atherosclerotic cardiovascular disease risk.
2013年美国心脏病学会/美国心脏协会《降低成人动脉粥样硬化性心血管疾病风险的血脂治疗指南》代表了与既往胆固醇管理指南的重大转变。新指南纳入了个体随机试验数据以及最全面的荟萃分析，并引入了几个重大的范式转变，其中包括：以降低动脉粥样硬化性心血管疾病（ASCVD）风险为目标，而非以低密度脂蛋白胆固醇（LDL-C）水平为靶点；提倡使用循证剂量的他汀类药物作为一线治疗；利用新的风险计算器和风险切点来指导他汀类药物治疗的启动。这些重大变化在医学界引发了争议和困惑，一些临床医生对接受这一转变犹豫不决。我们回顾了构成这些重大变化基础的证据，将它们与其他主要血脂指南进行比较，并推荐一种综合方法来管理血脂异常，以降低动脉粥样硬化性心血管疾病风险。
