Feingold Kenneth R, Chait Alan
University of California San Francisco, San Francisco, CA, USA.
Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA.
Best Pract Res Clin Endocrinol Metab. 2023 May;37(3):101658. doi: 10.1016/j.beem.2022.101658. Epub 2022 Apr 12.
Elevated low-density lipoprotein cholesterol (LDL-C) levels increase the risk of atherosclerotic cardiovascular disease (ASCVD) and lowering LDL-C levels reduces the risk of ASCVD. In patients with elevated LDL-C levels it is important to consider whether lifestyle, other medical conditions, medications, or genetic factors could be causing or contributing to the elevation. There are guidelines from various organizations outlining the approach to lowering LDL-C levels but while these guidelines agree on many issues there are numerous areas where recommendations are discordant. In this review, we outline several principles that will help in deciding who and how to treat patients with elevated LDL-C levels. Specifically, we discuss evidence indicating that the sooner one initiates therapy the better and the greater the reduction in LDL-C the better. Additionally, the higher the LDL-C level and the higher the risk of ASCVD, the greater the benefits of treatment. Using these principles will help in making decisions regarding the treatment of LDL-C levels.
低密度脂蛋白胆固醇（LDL-C）水平升高会增加动脉粥样硬化性心血管疾病（ASCVD）的风险，而降低LDL-C水平则会降低ASCVD的风险。对于LDL-C水平升高的患者，重要的是要考虑生活方式、其他疾病、药物或遗传因素是否可能导致或促成这种升高。各种组织都有关于降低LDL-C水平的指导方针，但虽然这些指导方针在许多问题上达成了一致，但在许多领域，建议并不一致。在这篇综述中，我们概述了几个原则，这些原则将有助于决定谁以及如何治疗LDL-C水平升高的患者。具体来说，我们讨论了证据表明，治疗开始得越早越好，LDL-C降低得越多越好。此外，LDL-C水平越高，ASCVD风险越高，治疗的益处就越大。运用这些原则将有助于做出关于治疗LDL-C水平的决策。
