Departments of Internal Medicine; Center for Human Nutrition of the University of Texas Southwestern Medical Center at Dallas, Texas; The Veterans Administration Medical Center at North Texas Healthcare System at Dallas, Texas.
Applied Clinical Research.
J Clin Lipidol. 2023 Jan-Feb;17(1):12-18. doi: 10.1016/j.jacl.2022.11.001. Epub 2022 Nov 24.
Current cholesterol guidelines for primary prevention of atherosclerotic cardiovascular disease (ASCVD) base statin treatment decisions on multiple risk factor algorithms (e.g., Pooled Cohort Equations [PCEs]). By available PCEs, most older middle-aged men are statin eligible. But several studies cast doubt on predictive accuracy of available PCEs for ASCVD risk assessment. Recent studies suggest that accuracy can be improved by measurement of coronary artery calcium (CAC). This method has the advantage of identifying men at low risk in whom statin therapy can be delayed for several years, provided they are monitored periodically for progression of CAC. Thus, there are two approaches to statin therapy in men ≥ 55 years: first all men could be treated routinely, or second, treatment can be based on the extent of coronary calcium. The latter could allow a sizable fraction of men to avoid treatment for several years or indefinitely. Whether with initial CAC scan or with periodic rescanning, a CAC score ≥ 100 Agatston units is high enough to warrant statin therapy. In otherwise high-risk men (e.g., diabetes, severe hypercholesterolemia, 10-year risk by PCE ≥ 20%), a statin is generally indicated without the need for CAC; but in special cases, CAC measurement may aid in treatment decisions.
现行的动脉粥样硬化性心血管疾病（ASCVD）一级预防胆固醇指南基于多种风险因素算法（如 Pooled Cohort Equations [PCE]）来制定他汀类药物治疗决策。根据现有的 PCE，大多数年龄较大的中年男性都符合他汀类药物治疗条件。但有几项研究对现有 PCE 进行 ASCVD 风险评估的预测准确性提出了质疑。最近的研究表明，通过测量冠状动脉钙（CAC）可以提高准确性。这种方法的优点是可以识别出处于低风险的男性，他们可以延迟几年接受他汀类药物治疗，只要他们定期监测 CAC 的进展情况即可。因此，≥55 岁男性的他汀类药物治疗有两种方法：第一种是所有男性都可以常规治疗，或者第二种是根据冠状动脉钙的程度来治疗。后者可以让很大一部分男性在几年或无限期内避免治疗。无论是初始 CAC 扫描还是定期复查，CAC 评分≥100 个 Agatston 单位足以证明需要进行他汀类药物治疗。在其他高危男性（如糖尿病、严重高胆固醇血症、PCE 预测 10 年风险≥20%）中，一般需要他汀类药物治疗，而无需进行 CAC 检查；但在特殊情况下，CAC 测量可能有助于治疗决策。
