Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities, University of Palermo, Palermo, Italy.
Polish Mother's Memorial Hospital Research Institute (PMMHRI) in Lodz, Lodz, Poland.
Atherosclerosis. 2021 May;325:99-109. doi: 10.1016/j.atherosclerosis.2021.03.039. Epub 2021 Apr 13.
This European Atherosclerosis Society (EAS) Task Force provides practical guidance for combination therapy for elevated low-density lipoprotein cholesterol (LDL-C) and/or triglycerides (TG) in high-risk and very-high-risk patients.
Evidence-based review.
Statin-ezetimibe combination treatment is the first choice for managing elevated LDL-C and should be given upfront in very-high-risk patients with high LDL-C unlikely to reach goal with a statin, and in primary prevention familial hypercholesterolaemia patients. A proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor may be added if LDL-C levels remain high. In high and very-high-risk patients with mild to moderately elevated TG levels (>2.3 and < 5.6 mmol/L [>200 and < 500 mg/dL) on a statin, treatment with either a fibrate or high-dose omega-3 fatty acids (icosapent ethyl) may be considered, weighing the benefit versus risks. Combination with fenofibrate may be considered for both macro- and microvascular benefits in patients with type 2 diabetes mellitus.
This guidance aims to improve real-world use of guideline-recommended combination lipid modifying treatment.
本欧洲动脉粥样硬化学会（EAS）工作组为高危和极高危患者升高的低密度脂蛋白胆固醇（LDL-C）和/或甘油三酯（TG）的联合治疗提供了实用的指导。
基于证据的综述。
他汀类药物与依折麦布联合治疗是治疗升高的 LDL-C 的首选方法，对于 LDL-C 极高危患者，尤其是那些使用他汀类药物后 LDL-C 仍难以达标或存在家族性高胆固醇血症的患者，应首先使用。如果 LDL-C 水平仍然较高，可以加用前蛋白转化酶枯草溶菌素 9（PCSK9）抑制剂。对于服用他汀类药物后 TG 水平轻度至中度升高（>2.3 且<5.6 mmol/L[>200 且<500 mg/dL]）的高危和极高危患者，权衡利弊后，可考虑使用贝特类药物或高剂量欧米伽-3 脂肪酸（二十碳五烯酸乙酯）治疗。对于 2 型糖尿病患者，联合使用非诺贝特可能对大血管和微血管均有益处。
本指南旨在改善指南推荐的联合降脂治疗在实际应用中的使用情况。
