Sinning D, Landmesser U
Klinik für Kardiologie, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland.
Berlin Institute of Health (BIH), Berlin, Deutschland.
Herz. 2016 Dec;41(8):671-676. doi: 10.1007/s00059-016-4505-6.
Dyslipidaemia is a major cause of atherosclerotic cardiovascular disease and its progression towards clinical complications, such as acute coronary syndromes and stroke. In August 2016 the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) issued new joint guidelines for the management of dyslipidaemias. In these new guidelines, the concept of treating patients to a risk-based low-density lipoprotein (LDL) cholesterol target is reinforced. The task force considers LDL cholesterol as the primary target for dyslipidaemia treatment, whereas high-density lipoprotein (HDL) cholesterol is not recommended as a treatment target (based on the failure of HDL cholesterol elevation treatment strategies to reduce cardiovascular risk in recent studies). In patients with a very high risk for cardiovascular events it is recommended to treat to an LDL cholesterol target of less than 70 mg/dl. Moreover, the new guidelines now additionally recommend a > 50% reduction of LDL cholesterol in patients with very high cardiovascular risk patients and baseline levels between 70 and 135 mg/dl as well as in patients with high cardiovascular risk and baseline LDL cholesterol levels between 100 and 200 mg/dl. Statins are recommended as first-line medicinal treatment and the LDL cholesterol goals given imply the more frequent use of maximum tolerated statin therapy, in particular for patients with very high cardiovascular risk. Treatment with ezetimibe in patients with substantially elevated LDL cholesterol levels despite maximum tolerated statin therapy has now received a stronger recommendation (currently IIa recommendation). The guidelines also now include the potential use of the novel proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and a recent ESC/EAS consensus document provides more detailed information on which patients can be considered for treatment with PCSK9 inhibitors, i. e. in particular patients with familial hypercholesterolemia and patients at very high cardiovascular risk who have markedly elevated LDL cholesterol levels despite maximum tolerated statin and ezetimibe therapy.
血脂异常是动脉粥样硬化性心血管疾病及其向临床并发症（如急性冠状动脉综合征和中风）发展的主要原因。2016年8月，欧洲心脏病学会（ESC）和欧洲动脉粥样硬化学会（EAS）发布了血脂异常管理的新联合指南。在这些新指南中，强化了根据风险设定低密度脂蛋白（LDL）胆固醇治疗目标来治疗患者的概念。工作组将LDL胆固醇视为血脂异常治疗的主要目标，而不推荐将高密度脂蛋白（HDL）胆固醇作为治疗目标（基于近期研究中HDL胆固醇升高治疗策略未能降低心血管风险）。对于心血管事件极高风险的患者，建议将LDL胆固醇目标降至低于70mg/dl。此外，新指南现在还额外建议，心血管风险极高且基线水平在70至135mg/dl之间的患者以及心血管风险高且基线LDL胆固醇水平在100至200mg/dl之间的患者，将LDL胆固醇降低>50%。推荐他汀类药物作为一线药物治疗，给定的LDL胆固醇目标意味着更频繁地使用最大耐受剂量的他汀类治疗，特别是对于心血管风险极高的患者。对于尽管接受了最大耐受剂量他汀类治疗但LDL胆固醇水平仍大幅升高的患者，依泽替米贝治疗现在得到了更强的推荐（目前为IIa类推荐）。指南现在还纳入了新型前蛋白转化酶枯草溶菌素/kexin 9型（PCSK9）抑制剂的潜在应用，并且最近的一份ESC/EAS共识文件提供了更详细信息，说明哪些患者可考虑使用PCSK9抑制剂治疗，即特别是家族性高胆固醇血症患者以及心血管风险极高且尽管接受了最大耐受剂量他汀类和依泽替米贝治疗但LDL胆固醇水平仍显著升高的患者。
