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2018年美国心脏协会/美国心脏病学会/美国心血管和肺康复协会/美国医师助理学会/美国心脏协会高血压委员会/美国预防医学学院/美国糖尿病协会/美国老年医学会/美国药剂师协会/美国临床内分泌医师协会/美国国家脂质协会/美国初级保健医师学会糖尿病患者血脂管理指南

The 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guidelines on the Management of Blood Cholesterol in Diabetes.

作者信息

Goldberg Ronald B, Stone Neil J, Grundy Scott M

机构信息

Division of Endocrinology, Diabetes and Metabolism, University of Miami Miller School of Medicine, Miami, FL

Feinberg School of Medicine, Northwestern University, Chicago, IL.

出版信息

Diabetes Care. 2020 Aug;43(8):1673-1678. doi: 10.2337/dci19-0036.

Abstract

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.

摘要

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。

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