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生育期女性血脂异常管理:国家脂质协会专家临床共识。

Dyslipidemia management in women of reproductive potential: An Expert Clinical Consensus from the National Lipid Association.

机构信息

Center for Cardiovascular Disease Prevention Cardiovascular Division, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, TX, USA (Dr Agarwala).

Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia, USA (Dr Dixon); Center for Pharmacy Practice Innovation, Virginia Commonwealth University, Richmond, Virginia, USA (Dr Dixon).

出版信息

J Clin Lipidol. 2024 Sep-Oct;18(5):e664-e684. doi: 10.1016/j.jacl.2024.05.005. Epub 2024 May 31.

Abstract

Cardiovascular disease (CVD) is the leading cause of death among women and its incidence has been increasing recently, particularly among younger women. Across major professional society guidelines, dyslipidemia management remains a central tenet for atherosclerotic CVD prevention for both women and men. Despite this, women, particularly young women, who are candidates for statin therapy are less likely to be treated and less likely to achieve their recommended therapeutic objectives for low-density lipoprotein cholesterol (LDL-C) levels. Elevated LDL-C and triglycerides are the two most common dyslipidemias that should be addressed during pregnancy due to the increased risk for adverse pregnancy outcomes, such as preeclampsia, gestational diabetes mellitus, and pre-term delivery, as well as pancreatitis in the presence of severe hypertriglyceridemia. In this National Lipid Association Expert Clinical Consensus, we review the roles of nutrition, physical activity, and pharmacotherapy as strategies to address elevated levels of LDL-C and/or triglycerides among women of reproductive age. We include a special focus on points to consider during the shared decision-making discussion regarding pharmacotherapy for dyslipidemia during preconception planning, pregnancy, and lactation.

摘要

心血管疾病(CVD)是女性死亡的主要原因,其发病率最近一直在上升,尤其是在年轻女性中。在主要的专业学会指南中,血脂异常管理仍然是预防女性和男性动脉粥样硬化性 CVD 的核心原则。尽管如此,他汀类药物治疗的候选人群——尤其是年轻女性,接受治疗的可能性较低,且实现低密度脂蛋白胆固醇(LDL-C)水平推荐治疗目标的可能性也较低。在妊娠期间,升高的 LDL-C 和甘油三酯是两种最常见的血脂异常,需要进行治疗,因为它们会增加不良妊娠结局的风险,如子痫前期、妊娠期糖尿病和早产,以及在严重高甘油三酯血症的情况下发生胰腺炎。在本次国家脂质协会专家临床共识中,我们回顾了营养、身体活动和药物治疗作为降低育龄妇女 LDL-C 和/或甘油三酯水平的策略的作用。我们特别关注在关于备孕、妊娠和哺乳期血脂异常药物治疗的共同决策讨论中需要考虑的要点。

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