Aguiar Carlos, Alegria Eduardo, Bonadonna Riccardo C, Catapano Alberico L, Cosentino Francesco, Elisaf Moses, Farnier Michel, Ferrières Jean, Filardi Pasquale Perrone, Hancu Nicolae, Kayikcioglu Meral, Mello E Silva Alberto, Millan Jesus, Reiner Željko, Tokgozoglu Lale, Valensi Paul, Viigimaa Margus, Vrablik Michal, Zambon Alberto, Zamorano José Luis, Ferrari Roberto
Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, EPE, Carnaxide, Portugal.
Cardiology Department, Policlínica Gipuzkoa, San Sebastián, Spain.
Atheroscler Suppl. 2015 Sep;19:1-12. doi: 10.1016/S1567-5688(15)30001-5.
A meeting of European experts in cardiovascular (CV) disease and lipids was convened in Paris, France, on 10 November 2014 to discuss lipid profile, and in particular atherogenic dyslipidaemia (AD), and associated CV risk. Key points that were raised and discussed during the meeting are summarised in this paper, which also accounts for further discussion and agreement on these points by the group of experts. Elevated levels of low-density lipoprotein cholesterol (LDL-c) are commonly associated with a greater CV risk than low LDL-c levels, and are routinely managed with statins. However, even for patients controlled on statins and achieving low LDL-c levels, abnormal lipid profiles observed in some patients (i.e. elevated triglyceride levels, with/without low levels of high-density lipoprotein cholesterol [HDL-c]) have been linked to the presence of a residual CV risk. Therefore, it is recommended that both triglyceride and HDL-c levels be measured, to allow for the overall CV residual risk to be adequately managed. Favourable safety and clinical data support the combination of statins with other lipid-lowering agents, such as fenofibrate. Patients who have elevated triglyceride levels plus low levels of HDL-c are most likely to achieve clinical benefit from fenofibrate-statin combination therapy. In these patients with AD, achieving target non-HDL-c levels should be a key focus of CV risk management, and the use of non-HDL-c was advocated to provide a better measure of CV risk than LDL-c levels.
2014年11月10日，欧洲心血管疾病与血脂专家会议在法国巴黎召开，会议旨在讨论血脂水平，尤其是致动脉粥样硬化性血脂异常（AD）及其相关的心血管风险。本文总结了会议期间提出并讨论的要点，同时也阐述了专家小组对这些要点的进一步讨论及达成的共识。通常情况下，低密度脂蛋白胆固醇（LDL-c）水平升高比LDL-c水平低时的心血管风险更高，临床上常用他汀类药物进行治疗。然而，即便对于使用他汀类药物治疗且LDL-c水平达标的患者，部分患者出现的异常血脂情况（即甘油三酯水平升高，伴或不伴有高密度脂蛋白胆固醇[HDL-c]水平降低）也与残余心血管风险相关。因此，建议同时检测甘油三酯和HDL-c水平，以便对整体心血管残余风险进行充分管理。良好的安全性和临床数据支持他汀类药物与其他降脂药物（如非诺贝特）联合使用。甘油三酯水平升高且HDL-c水平降低的患者最有可能从非诺贝特-他汀联合治疗中获益。对于这些患有AD的患者，实现非HDL-c目标水平应成为心血管风险管理的关键重点，提倡使用非HDL-c来更好地评估心血管风险，而非LDL-c水平。
