Goldberg Ronald B, Stone Neil J, Grundy Scott M
Division of Endocrinology, Diabetes and Metabolism, University of Miami Miller School of Medicine, Miami, FL
Feinberg School of Medicine, Northwestern University, Chicago, IL.
Diabetes Care. 2020 Aug;43(8):1673-1678. doi: 10.2337/dci19-0036.
The American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines recently published its 2018 recommendations on management of LDL cholesterol (LDL-C) in people with diabetes. For primary prevention, moderate-intensity statin therapy is recommended for those aged 40-75 years, with a preference for high-intensity statin treatment for older subjects and for those with higher estimated risk or risk-enhancing factors following a patient-clinician discussion. Statin therapy may be reasonable in adults <40 years or >75 years of age where there is less evidence for benefit. For people with diabetes and established atherosclerotic cardiovascular disease, high-intensity statin therapy is recommended. The majority of these subjects have very high risk, and an LDL-C goal of <70 mg/dL is recommended. If this target is not achieved, ezetimibe and/or a proprotein convertase subtilisin/kexin type 9 inhibitor may be added.
美国心脏病学会/美国心脏协会临床实践指南特别工作组最近发布了其2018年关于糖尿病患者低密度脂蛋白胆固醇（LDL-C）管理的建议。对于一级预防，建议40 - 75岁的患者接受中等强度他汀类药物治疗，对于老年患者以及在与患者 - 临床医生讨论后具有较高估计风险或风险增强因素的患者，优先选择高强度他汀类药物治疗。对于年龄小于40岁或大于75岁的成年人，他汀类药物治疗可能是合理的，但获益证据较少。对于患有糖尿病且已确诊动脉粥样硬化性心血管疾病的患者，建议采用高强度他汀类药物治疗。这些患者大多数具有非常高的风险，建议将LDL-C目标设定为低于70mg/dL。如果未达到该目标，可添加依折麦布和/或前蛋白转化酶枯草溶菌素9型抑制剂。
