Temple University School of Pharmacy, 1625 Annin St, Philadelphia, PA, 19146, USA.
Cardiovascular Division, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Curr Cardiol Rep. 2018 May 25;20(7):55. doi: 10.1007/s11886-018-0997-4.
There has been confusion following the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Lipid guidelines on the role of non-statin medications for cardiovascular prevention.
Several recent large trials have also now shown that lowering LDL with non-statins reduces cardiovascular events. In ASCVD patients on statins, adding ezetimibe or a PCSK9 inhibitor led to reductions in CV events in the IMPROVE IT, FOURIER, and most recently the ODYSSEY-OUTCOMES trials. Additional novel therapies reducing LDL and other atherogenic lipoproteins are in development during this exciting time in this field. With recent evidence, the 2017 ACC Expert Consensus Decision pathway calls for initial therapy with statins, monitoring LDL levels, and then adding ezetimibe and/or PCSK9 inhibitors to further lower LDL-C to targets based on the patient's risk.
2013 年美国心脏病学会/美国心脏协会（ACC/AHA）血脂指南发布后，关于非他汀类药物在心血管预防中的作用存在混淆。
最近的几项大型试验也表明，用非他汀类药物降低 LDL 可减少心血管事件。在服用他汀类药物的 ASCVD 患者中，添加依折麦布或 PCSK9 抑制剂可使 IMPROVE IT、FOURIER 以及最近的 ODYSSEY-OUTCOMES 试验中的 CV 事件减少。在此激动人心的领域，目前正在开发其他降低 LDL 和其他致动脉粥样硬化脂蛋白的新型疗法。根据最近的证据，2017 年 ACC 专家共识决策途径呼吁初始他汀类药物治疗，监测 LDL 水平，然后添加依折麦布和/或 PCSK9 抑制剂，根据患者的风险将 LDL-C 进一步降低至目标水平。
