Center for the Study of Atherosclerosis, E. Bassini Hospital, Cinisello Balsamo, Milan, Italy.
Center for the Study of Dyslipidaemias, Multimedica IRCCS, Milan, Italy.
Nat Rev Cardiol. 2021 Oct;18(10):689-700. doi: 10.1038/s41569-021-00541-4. Epub 2021 Apr 8.
Dyslipidaemias are alterations to the plasma lipid profile that are often associated with clinical conditions. Dyslipidaemias, particularly elevated plasma LDL-cholesterol levels, are major risk factors for cardiovascular disease, but some forms, such as hypertriglyceridaemia, are associated with severe diseases in other organ systems, including non-alcoholic fatty liver disease and acute pancreatitis. Dyslipidaemias can be genetically determined (primary or familial dyslipidaemias) or secondary to other conditions (such as diabetes mellitus, obesity or an unhealthy lifestyle), the latter being more common. Hypercholesterolaemia is the most common form of dyslipidaemia and is associated with an increased risk of cardiovascular disease, with elevated plasma LDL-cholesterol levels being the 15th leading risk factor for death in 1990, rising to 11th in 2007 and 8th in 2019. The global burden of dyslipidaemias has increased over the past 30 years. Furthermore, the combination of high triglyceride levels and low HDL-cholesterol levels (together with the presence of small, dense LDL particles), referred to as atherogenic dyslipidaemia, is highly prevalent in patients with diabetes or metabolic syndrome and increases their risk of cardiovascular disease. Given the increasing prevalence of diabetes worldwide, treating lipid abnormalities in these patients might reduce their risk of cardiovascular disease.
血脂异常是指血浆脂质谱的改变,常与临床疾病有关。血脂异常,特别是血浆 LDL 胆固醇水平升高,是心血管疾病的主要危险因素,但某些形式,如高甘油三酯血症,与其他器官系统的严重疾病有关,包括非酒精性脂肪性肝病和急性胰腺炎。血脂异常可以是遗传决定的(原发性或家族性血脂异常)或继发于其他疾病(如糖尿病、肥胖或不健康的生活方式),后者更为常见。高胆固醇血症是最常见的血脂异常形式,与心血管疾病风险增加有关,1990 年血浆 LDL 胆固醇水平升高是第 15 大死亡风险因素,2007 年上升至第 11 位,2019 年上升至第 8 位。过去 30 年来,血脂异常的全球负担一直在增加。此外,高甘油三酯水平和低 HDL 胆固醇水平(以及小而密 LDL 颗粒的存在)的组合,称为致动脉粥样硬化性血脂异常,在糖尿病或代谢综合征患者中非常普遍,增加了他们患心血管疾病的风险。鉴于全球糖尿病患病率的增加,治疗这些患者的血脂异常可能会降低其患心血管疾病的风险。