Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA.
Division of Metabolism, Endocrinology and Nutrition, University of Washington, RR-512 Health Sciences Building, Box 356420, 1959 NE Pacific Street, Seattle, WA 98195-6420, USA.
Med Clin North Am. 2024 Sep;108(5):881-894. doi: 10.1016/j.mcna.2024.03.005. Epub 2024 Jun 4.
Significant advances in atherosclerotic cardiovascular (ASCVD) risk stratification and treatment have occurred over the past 10 years. While the lipid panel continues to be the basis of risk estimation, imaging for coronary artery calcium is now widely used in estimating risk at the individual level. Statins remain first-line agents for ASCVD risk reduction but in high-risk patients, ezetimibe, proprotein convertase subtilisin kexin-9 inhibitors, and bempedoic acid can be added to further reduce individual cardiovascular risk based on results of cardiovascular outcomes trials. Results of randomized control trials do not support use of medications targeted at triglyceride lowering for ASCVD risk reduction, but icosapent ethyl can be considered.
在过去的 10 年中，动脉粥样硬化性心血管疾病（ASCVD）风险分层和治疗取得了重大进展。虽然血脂谱仍然是风险估计的基础，但冠状动脉钙成像现在广泛用于个体水平的风险估计。他汀类药物仍然是降低 ASCVD 风险的一线药物，但对于高危患者，依折麦布、前蛋白转化酶枯草溶菌素 9 抑制剂和贝匹地酸可根据心血管结局试验的结果添加，以进一步降低个体心血管风险。随机对照试验的结果不支持使用针对降低甘油三酯的药物来降低 ASCVD 风险，但可以考虑使用icosapent ethyl。
