Pedro-Botet Juan, Barrios Vivencio, Pascual Vicente, Ascaso Juan F, Cases Aleix, Millán Jesús, Serrano Adalberto, Pintó Xavier
Unidad de Lípidos y Riesgo Vascular, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España.
Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España.
Clin Investig Arterioscler. 2016 May-Jun;28(3):132-40. doi: 10.1016/j.arteri.2015.12.003. Epub 2016 Mar 2.
The aim of the present study was to develop a multidisciplinary consensus based on the Delphi system to establish clinical recommendations for the management of dyslipidaemia when hyperglycaemia is present, and the relevant factors that should be taken into consideration when prescribing and monitoring treatment with statins.
The questionnaire developed by the scientific committee included four blocks of questions about dyslipidaemia in patients with impaired glucose metabolism. The results of the first two blocks are presented here: a) management of dyslipidaemia; b) relevant factors that should be taken into consideration when prescribing and monitoring treatment with statins.
Among the 497 experts who participated in the study, an agreement of over 90% was attained for recommending screening for dyslipidaemia in patients with diabetes or pre-diabetes and/or cardiovascular disease or a family history and/or abdominal obesity and/or hypertension. There was a high degree of agreement that a statin is the lipid-lowering treatment of choice, and that it should be switched when side effects develop. Also, the choice of statin and dose should be made according to baseline LDL cholesterol levels, the target to achieve, and the possible drug-drug interactions.
The screening of dyslipidaemia is primarily conducted in patients with cardiovascular disease, or any major cardiovascular risk factor. When prescribing a statin, physicians mainly focus on the ability to reduce LDL cholesterol and the risk of drug interactions.
本研究旨在基于德尔菲系统达成多学科共识,以制定高血糖情况下血脂异常管理的临床建议,以及在开具和监测他汀类药物治疗时应考虑的相关因素。
科学委员会编制的问卷包括关于糖代谢受损患者血脂异常的四个问题板块。此处展示前两个板块的结果:a)血脂异常的管理;b)开具和监测他汀类药物治疗时应考虑的相关因素。
在参与研究的497位专家中,对于推荐对糖尿病或糖尿病前期患者和/或心血管疾病患者或有家族病史和/或腹型肥胖和/或高血压患者进行血脂异常筛查,达成了超过90%的共识。对于他汀类药物是降脂治疗的首选药物,以及出现副作用时应换药,存在高度共识。此外,他汀类药物的选择和剂量应根据基线低密度脂蛋白胆固醇水平、要达到的目标以及可能的药物相互作用来确定。
血脂异常筛查主要针对心血管疾病患者或任何主要心血管危险因素患者进行。开具他汀类药物时,医生主要关注降低低密度脂蛋白胆固醇的能力和药物相互作用风险。