Duke University School of Medicine, Biostatistics and Bioinformatics, Duke Clinical Research Institute, Durham, NC (M.J.P.).
Brigham and Women's Hospital, Harvard Medical School, Boston, MA (K.M.P.).
Circulation. 2020 Sep;142(9):827-837. doi: 10.1161/CIRCULATIONAHA.120.045851. Epub 2020 Jul 23.
BACKGROUND: Lipid-lowering recommendations for prevention of atherosclerotic cardiovascular disease rely principally on estimated 10-year risk. We sought to determine the optimal time for initiation of lipid lowering in younger adults as a function of expected 30-year benefit. METHODS: Data from 3148 National Health and Nutrition Examination Survey (2009-2016) participants, age 30 to 59 years, not eligible for lipid-lowering treatment recommendation under the most recent US guidelines, were analyzed. We estimated the absolute and relative impact of lipid lowering as a function of age, age at initiation, and non-high-density lipoprotein cholesterol (HDL-C) level on the expected rates of atherosclerotic cardiovascular disease over the succeeding 30 years. We modeled expected risk reductions based on shorter-term effects observed in statin trials (model A) and longer-term benefits based on Mendelian randomization studies (model B). RESULTS: In both models, potential reductions in predicted 30-year atherosclerotic cardiovascular disease risk were greater with older age and higher non-HDL-C level. Immediate initiation of lipid lowering (ie, treatment for 30 years) in 40- to 49-year-old patients with non-HDL-C ≥160 mg/dL would be expected to reduce their average predicted 30-year risk of 17.1% to 11.6% (model A; absolute risk reduction [ARR], 5.5%) or 6.5% (model B; ARR 10.6%). Delaying lipid lowering by 10 years (treatment for 20 years) would result in residual 30-year risk of 12.7% (A; ARR 4.4) or 9.9% (B; ARR 7.2%) and delaying by 20 years (treatment for 10 years) would lead to expected mean residual risk of 14.6% (A; ARR 2.6%) or 13.9% (B; ARR 3.2%). The slope of the achieved ARR as a function of delay in treatment was also higher with older age and higher non-HDL-C level. CONCLUSIONS: Substantial reduction in expected atherosclerotic cardiovascular disease risk in the next 30 years is achievable by intensive lipid lowering in individuals in their 40s and 50s with non-HDL-C ≥160 mg/dL. For many, the question of when to start lipid lowering might be more relevant than whether to start lipid lowering.
背景：降脂预防动脉粥样硬化性心血管疾病的建议主要依赖于估计的 10 年风险。我们试图确定在年轻成年人中开始降脂的最佳时间，这取决于预期的 30 年获益。
方法：分析了 3148 名年龄在 30 至 59 岁之间的国家健康和营养调查（2009-2016 年）参与者的数据，这些参与者不符合最近美国指南推荐的降脂治疗建议。我们根据年龄、起始年龄和非高密度脂蛋白胆固醇（HDL-C）水平，估计降脂治疗作为未来 30 年动脉粥样硬化性心血管疾病发生率的函数的绝对和相对影响。我们基于他汀类药物试验观察到的短期效果（模型 A）和基于孟德尔随机化研究的长期获益（模型 B）来预测降脂治疗的预期风险降低。
结果：在两种模型中，年龄较大和非 HDL-C 水平较高时，预测 30 年动脉粥样硬化性心血管疾病风险的降低幅度更大。在 40 至 49 岁、非 HDL-C≥160mg/dL 的患者中，立即开始降脂治疗（即治疗 30 年），预计可将其平均预测 30 年的动脉粥样硬化性心血管疾病风险从 17.1%降至 11.6%（模型 A；绝对风险降低[ARR]为 5.5%）或 6.5%（模型 B；ARR 为 10.6%）。将降脂治疗推迟 10 年（治疗 20 年）将导致 30 年残留风险为 12.7%（A；ARR 为 4.4%）或 9.9%（B；ARR 为 7.2%），将降脂治疗推迟 20 年（治疗 10 年）将导致预期的平均残留风险为 14.6%（A；ARR 为 2.6%）或 13.9%（B；ARR 为 3.2%）。与年龄较大和非 HDL-C 水平较高的患者相比，随着治疗延迟，实现的 ARR 斜率也更高。
结论：在非 HDL-C≥160mg/dL 的 40 多岁和 50 多岁的个体中进行强化降脂治疗，可以显著降低未来 30 年的动脉粥样硬化性心血管疾病风险。对于许多人来说，何时开始降脂可能比是否开始降脂更为重要。
Curr Diab Rep. 2019-11-21
J Manag Care Pharm. 2008-10
Am J Prev Cardiol. 2025-7-26
Curr Opin Lipidol. 2025-4-1
Am J Prev Cardiol. 2024-7-20
Zotero 插件