Volpe Massimo, Volpe Roberto, Gallo Giovanna, Presta Vivianne, Tocci Giuliano, Folco Emanuela, Peracino Andrea, Tremoli Elena, Trimarco Bruno
Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy.
IRCCS Neuromed, Pozzilli, IS, Italy.
High Blood Press Cardiovasc Prev. 2017 Sep;24(3):313-329. doi: 10.1007/s40292-017-0211-6. Epub 2017 May 18.
The benefits achieved by implementing cardiovascular prevention strategies in terms of reduced incidence of atherosclerotic diseases and mortality are accepted, worldwide. In particular, the clinical management of hypercholesterolemia has a fundamental role for all preventive strategies, both in primary and secondary prevention, at each stage of cardiovascular risk. Since the net clinical benefit of lipid-lowering therapy largely depends on baseline individual cardiovascular risk profile, the assessment of individual risk is essential to establish type and intensity of both preventive and therapeutic strategies. Thus, the real challenge in a setting of clinical practice is not only to identify whom to treat among individuals at low-to-moderate risk, but mostly how much and how long to treat high or very-high risk patients. This manuscript, which reflects concepts and positions that have been published in a more extensive document of the Italian Society for Cardiovascular Prevention (SIPREC), deals with the diagnostic and therapeutic management of patients with dyslipidaemia, with an evidence-based approach adapted and updated from recent guidelines of the European Society of Cardiology and very recent results of randomized clinical trials. The purpose is to suggest a multidimensional and integrated actions aimed at eliminating or minimizing the impact of cardiovascular diseases and their related disabilities and mortality in patients with hypercholesterolemia.
在全球范围内，实施心血管预防策略在降低动脉粥样硬化疾病发病率和死亡率方面所带来的益处已得到认可。特别是，高胆固醇血症的临床管理在心血管风险的各个阶段，无论是一级预防还是二级预防中，对所有预防策略都起着至关重要的作用。由于降脂治疗的净临床获益很大程度上取决于个体的基线心血管风险状况，因此评估个体风险对于确定预防和治疗策略的类型及强度至关重要。所以，临床实践中的真正挑战不仅在于识别低至中度风险个体中哪些需要治疗，更在于对高风险或极高风险患者进行治疗的剂量和时长。本手稿反映了已发表在意大利心血管预防协会（SIPREC）更详尽文件中的概念和立场，采用欧洲心脏病学会最新指南及近期随机临床试验的最新结果所改编和更新的循证方法，论述了血脂异常患者的诊断和治疗管理。目的是提出多维度和综合的行动，旨在消除或最小化心血管疾病及其相关残疾和死亡率对高胆固醇血症患者造成的影响。
