Department of Medicine and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine.
Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.
Curr Opin Endocrinol Diabetes Obes. 2021 Apr 1;28(2):114-121. doi: 10.1097/MED.0000000000000608.
The purpose of this review is to compare and contrast the key messages from the 2018 American Heart Association (AHA)/American College of Cardiology (ACC) Multisociety Guideline on the Management of Blood Cholesterol and the 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) Guidelines for the Management of Dyslipidemias. We also review some of the evidence that served as the basis for these guidelines and share our opinion regarding these guidelines.
Patients with atherosclerotic cardiovascular disease (ASCVD), severe hypercholesterolemia, familial hypercholesterolemia, or diabetes should be treated aggressively with lipid-lowering therapy. In addition to traditional risk factors included in risk scores, assessment of risk enhancers/modifiers may improve risk stratification. The addition of ezetimibe ± proprotein convertase subtilisin/kexin type 9 inhibitors plays an integral role in the management of very-high-risk ASCVD patients; the ESC/EAS guidelines support more aggressive use of these medications.
Both the AHA/ACC Multisociety and ESC/EAS guidelines provide an evidence-based approach to management of blood cholesterol. The greatest difference between these two guidelines is the classification and recommended management of very-high-risk patients. Implementation of either guideline will likely lead to improved ASCVD outcomes compared with current treatment practice.
本文旨在比较和对比 2018 年美国心脏协会（AHA）/美国心脏病学会（ACC）多学会指南《管理血液胆固醇》与 2019 年欧洲心脏病学会（ESC）/欧洲动脉粥样硬化学会（EAS）《血脂异常管理指南》的关键信息。我们还回顾了这些指南的一些依据，并分享了我们对这些指南的看法。
有动脉粥样硬化性心血管疾病（ASCVD）、严重高胆固醇血症、家族性高胆固醇血症或糖尿病的患者，应积极进行降脂治疗。除了风险评分中包含的传统风险因素外，评估风险增强/调节剂可能会改善风险分层。依折麦布联合或不联合前蛋白转化酶枯草溶菌素 9 抑制剂的应用在极高危 ASCVD 患者的管理中起着重要作用；ESC/EAS 指南支持更积极地使用这些药物。
AHA/ACC 多学会和 ESC/EAS 指南都为管理血液胆固醇提供了循证方法。这两个指南之间最大的区别是极高危患者的分类和推荐管理。与当前的治疗实践相比，实施这两个指南中的任何一个都可能导致 ASCVD 结局的改善。
