Sinning David, Landmesser Ulf
1 Department of Cardiology, Charité - University Medicine Berlin (Campus Benjamin Franklin), Germany.
2 Berlin Institute of Health (BIH), Germany.
Eur J Prev Cardiol. 2017 Jun;24(3_suppl):71-76. doi: 10.1177/2047487317708349.
Although age-adjusted mortality of coronary heart disease has been successfully reduced over recent years, coronary heart disease still represents a leading cause of death and morbidity, in particular in patients at very high cardiovascular risk. Dyslipidaemia plays a major and causal role in the development and clinical progression of coronary heart disease. At present, low-density lipoprotein cholesterol represents the primary target of lipid-directed therapies for the prevention of cardiovascular disease and events. The new European guidelines recommend intensive statin therapy and the possible addition of ezetimibe to reduce low-density lipoprotein cholesterol to a goal of less than 1.8 mmol/L (<70 mg/dL) or by at least 50% if the baseline low-density lipoprotein cholesterol is between 1.8 and 3.5 mmol/L (70-135 mg/dL) in patients at very high cardiovascular risk. Also, the new European guidelines now mention the potential use of proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors in very high-risk patients with persistently high levels of low-density lipoprotein cholesterol despite maximally tolerated statin treatment in combination with ezetimibe or in patients with statin intolerance. A recent European consensus document discusses the practical clinical use of PCSK9 inhibitors and provides more detailed recommendations. However, despite the overwhelming scientific evidence of the beneficial effects of lipid-lowering therapies, a large proportion of patients at very high cardiovascular risk are not treated according to the current European guideline recommendations. Reinforcing lipid-lowering therapies provides an excellent chance effectively to reduce morbidity and mortality from coronary heart disease.
尽管近年来经年龄调整的冠心病死亡率已成功降低，但冠心病仍是主要的死亡和发病原因，特别是在心血管风险极高的患者中。血脂异常在冠心病的发生和临床进展中起主要且因果性作用。目前，低密度脂蛋白胆固醇是预防心血管疾病及事件的脂质靶向治疗的主要目标。新的欧洲指南推荐强化他汀类药物治疗，并可能加用依折麦布，以使低密度脂蛋白胆固醇降低至低于1.8 mmol/L（<70 mg/dL）的目标水平，或者在心血管风险极高的患者中，如果基线低密度脂蛋白胆固醇在1.8至3.5 mmol/L（70 - 135 mg/dL）之间，则使其降低至少50%。此外，新的欧洲指南现在提到，对于尽管接受了最大耐受剂量的他汀类药物联合依折麦布治疗但低密度脂蛋白胆固醇水平仍持续升高的极高风险患者，或对于他汀类药物不耐受的患者，可能使用前蛋白转化酶枯草溶菌素9型（PCSK9）抑制剂。最近的一份欧洲共识文件讨论了PCSK9抑制剂的实际临床应用，并提供了更详细的建议。然而，尽管有压倒性的科学证据表明降脂治疗有益，但很大一部分心血管风险极高的患者并未按照当前欧洲指南的建议接受治疗。加强降脂治疗为有效降低冠心病的发病率和死亡率提供了绝佳机会。
