Parhofer K G
Medizinische Klinik IV - Großhadern, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland.
Internist (Berl). 2020 Jun;61(6):573-586. doi: 10.1007/s00108-020-00799-9.
The treatment of elevated plasma lipids plays an important role in atherosclerosis prevention. Low-density lipoprotein (LDL) cholesterol lowering with statins and, if required, additional inhibition is of the utmost importance. Lifestyle modification plays only a minor role in LDL cholesterol lowering. Absolute cardiovascular risk determines whether and at what intensity lipid lowering therapy should be implemented. Thus, in patients at very high risk, an LDL cholesterol level <55 mg/dl (<1.4 mmol/l) and a 50% reduction from baseline should be achieved. With respect to elevated triglyceride concentrations, treatment goals are less clearly defined, despite the fact that elevated triglyceride concentrations are causally linked to atherosclerotic events. Lifestyle modification can significantly reduce triglyceride concentrations and are often more effective than specific triglyceride lowering medications. New lipid lowering drugs still need to prove their clinical benefit in endpoint trials.
血浆脂质升高的治疗在动脉粥样硬化预防中起着重要作用。使用他汀类药物降低低密度脂蛋白(LDL)胆固醇,如有必要,进行额外抑制至关重要。生活方式改变在降低LDL胆固醇方面仅起次要作用。绝对心血管风险决定了是否以及应以何种强度实施降脂治疗。因此,对于极高风险患者,应将LDL胆固醇水平降至<55 mg/dl(<1.4 mmol/l),并较基线水平降低50%。尽管甘油三酯浓度升高与动脉粥样硬化事件存在因果关系,但关于甘油三酯浓度升高的治疗目标尚不太明确。生活方式改变可显著降低甘油三酯浓度,且通常比特定的降甘油三酯药物更有效。新型降脂药物仍需在终点试验中证明其临床益处。