Department of Cardiology, Changzheng Hospital, Naval Military Medical University, Shanghai, People's Republic of China.
J Cardiovasc Pharmacol. 2020 Dec;76(6):658-670. doi: 10.1097/FJC.0000000000000914.
Dyslipidemia is a major risk factor for cardiovascular (CV) disease, which is the leading cause of death globally. Acute coronary syndrome (ACS) is a common cause of death, accounting for nearly half of the global burden of CV mortality. Epidemiologic studies have identified low-density lipoprotein cholesterol (LDL-C) as an independent CV risk factor, and this is now the primary target for initiating and adjusting lipid-lowering therapies in most current guidelines. Evidence from pivotal studies supports the use of high-intensity statin therapy and a lower level for optimal LDL-C in secondary prevention of atherosclerotic CV disease, especially in patients with ACS undergoing percutaneous coronary intervention. However, current research has identified a gap between the target LDL-C goal attainment and target LDL-C levels recommended by the guidelines. Statins have proven benefits in the management of CV disease and are the cornerstone of lipid-lowering management in patients with ACS. Recent randomized controlled trials have also demonstrated the benefits of cholesterol absorption inhibitors and proprotein convertase subtilisin/kexin type 9 inhibitors. This review summarizes the current evidence for LDL-lowering therapy in patients with ACS, with an emphasis on the importance of LDL-C goal attainment, rapid LDL-C lowering, and duration of LDL-C-lowering therapy.
血脂异常是心血管疾病（CV）的一个主要危险因素，它是全球范围内的主要死亡原因。急性冠状动脉综合征（ACS）是常见的死亡原因，占全球 CV 死亡率负担的近一半。流行病学研究已经确定了低密度脂蛋白胆固醇（LDL-C）是一个独立的 CV 危险因素，这也是目前大多数指南中启动和调整降脂治疗的主要目标。来自关键研究的证据支持在动脉粥样硬化性 CV 疾病的二级预防中使用高强度他汀类药物治疗和更低的 LDL-C 水平，特别是在接受经皮冠状动脉介入治疗的 ACS 患者中。然而，目前的研究发现，目标 LDL-C 达标率与指南推荐的目标 LDL-C 水平之间存在差距。他汀类药物在 CV 疾病管理中的已被证明具有益处，是 ACS 患者降脂管理的基石。最近的随机对照试验也证明了胆固醇吸收抑制剂和前蛋白转化酶枯草溶菌素/糜蛋白酶 9 抑制剂的益处。本综述总结了 ACS 患者 LDL 降低治疗的现有证据，重点强调了 LDL-C 目标达标、快速 LDL-C 降低和 LDL-C 降低治疗持续时间的重要性。
