Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY 40536-0200, United States.
Curr Vasc Pharmacol. 2019;17(3):270-277. doi: 10.2174/1570161116666180123112956.
The non-traditional cardiovascular (CV) risk factors that appear to be of most clinical interest include: apolipoprotein A (ApoA), apolipoprotein B (ApoB), high-sensitivity C-Reactive protein (hsCRP), homocysteine, interleukin 1 (IL1), lipoprotein (a) [Lp(a)], the density of low-density lipoprotein (LDL) particles, the LDL particle number, tissue/tumor necrosis factor-α (TNF-α) and uric acid. These non-traditional risk factors may be of value in adding further confirmation and attention to suspected significant CV risk. They can also provide a better understanding of current concepts of atherogenesis (e.g. various potential mechanisms associated with inflammation) as an etiology and in guiding current plus future therapies. In the mid-20th century, atherosclerosis and CV disease were considered mechanistic occurrences with essentially no attention to possible metabolic and molecular etiologies. Therefore, the only treatments then centered around mainly surgical procedures to try to improve blood flow, first with peripheral arterial disease (PAD) and later coronary artery disease (CAD). Now, failure to treat CV risk factors, especially where there is good evidence-based medicine, as in the case of statins for high CV risk patients, is considered medical negligence. Nevertheless, many problems remain to be solved regarding atherosclerosis prevention and treatment.
看来最具临床意义的非传统心血管（CV）危险因素包括：载脂蛋白 A（ApoA）、载脂蛋白 B（ApoB）、高敏 C 反应蛋白（hsCRP）、同型半胱氨酸、白细胞介素 1（IL1）、脂蛋白（a）[Lp(a)]、低密度脂蛋白（LDL）颗粒密度、LDL 颗粒数、组织/肿瘤坏死因子-α（TNF-α）和尿酸。这些非传统危险因素可能有助于进一步证实和关注可疑的重大 CV 风险。它们还可以更好地了解动脉粥样硬化形成的当前概念（例如，与炎症相关的各种潜在机制），并指导当前和未来的治疗。在 20 世纪中叶，动脉粥样硬化和 CV 疾病被认为是机械性发生的，基本上没有注意到可能的代谢和分子病因。因此，当时的唯一治疗方法主要是手术，试图改善血流，首先是外周动脉疾病（PAD），后来是冠状动脉疾病（CAD）。现在，不治疗 CV 危险因素，特别是在有良好循证医学证据的情况下，例如高 CV 风险患者的他汀类药物，被认为是医疗疏忽。然而，在动脉粥样硬化预防和治疗方面仍有许多问题需要解决。
