Chao Ting-Hsing, Lin Tsung-Hsien, Cheng Cheng-I, Wu Yen-Wen, Ueng Kwo-Chang, Wu Yih-Jer, Lin Wei-Wen, Leu Hsing-Ban, Cheng Hao-Min, Huang Chin-Chou, Wu Chih-Cheng, Lin Chao-Feng, Chang Wei-Ting, Pan Wen-Han, Chen Pey-Rong, Ting Ke-Hsin, Su Chun-Hung, Chu Chih-Sheng, Chien Kuo-Liong, Yen Hsueh-Wei, Wang Yu-Chen, Su Ta-Chen, Liu Pang-Yen, Chang Hsien-Yuan, Chen Po-Wei, Juang Jyh-Ming Jimmy, Lu Ya-Wen, Lin Po-Lin, Wang Chao-Ping, Ko Yu-Shien, Chiang Chern-En, Hou Charles Jia-Yin, Wang Tzung-Dau, Lin Yen-Hung, Huang Po-Hsun, Chen Wen-Jone
Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan.
Division of Cardiology, Department of Internal Medicine, Chung-Shan Medical University Hospital; School of Medicine, Chung Shan Medical University, Taichung.
Acta Cardiol Sin. 2024 Nov;40(6):669-715. doi: 10.6515/ACS.202411_40(6).20240724B.
For the primary prevention of atherosclerotic cardiovascular disease (ASCVD), the recommended treatment target for each modifiable risk factor is as follows: reducing body weight by 5-10%; blood pressure < 130/80 mmHg (systolic pressure < 120 mmHg in high-risk individuals); low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL in high-risk individuals, LDL-C < 115 mg/dL in moderate-risk individuals, LDL-C < 130 mg/dL in low-risk individuals, and LDL-C < 160 mg/dL in those with a minimal; complete and persistent abstinence from cigarette smoking; hemoglobin A1C < 7.0%; fulfilling recommended amounts of the six food groups according to the Taiwan food guide; and moderate-intensity physical activity 150 min/wk or vigorous physical activity 75 min/wk. For the primary prevention of ASCVD by pharmacological treatment in individuals with modifiable risk factors/clinical conditions, statins are the first-line therapy for reducing LDL-C levels; some specific anti-diabetic drugs proven to be effective in randomized controlled trials for the primary prevention of ASCVD are recommended in patients with type 2 diabetes mellitus; pharmacological treatment is recommended to assist in weight management for obese patients with a body mass index ≥ 30 kg/m (or 27 kg/m who also have at least one ASCVD risk factor or obesity-related comorbidity); an angiotensin-converting enzyme inhibitor, a glucagon-like peptide-1 receptor agonist, a sodium-dependent glucose cotransporter-2 inhibitor, and finerenone can be used in diabetic patients with chronic kidney disease for the primary prevention of ASCVD. Of note, healthcare providers are at full discretion in clinical practice, owing to the diversity of individuals and practice, and the availability of resources and facilities.
对于动脉粥样硬化性心血管疾病（ASCVD）的一级预防，针对每个可改变的危险因素的推荐治疗目标如下：体重减轻5-10%；血压<130/80 mmHg（高危个体收缩压<120 mmHg）；高危个体低密度脂蛋白胆固醇（LDL-C）<100 mg/dL，中危个体LDL-C<115 mg/dL，低危个体LDL-C<130 mg/dL，极低危个体LDL-C<160 mg/dL；完全且持续戒烟；糖化血红蛋白A1C<7.0%；按照台湾食物指南达到推荐的六类食物摄入量；中等强度体力活动每周150分钟或高强度体力活动每周75分钟。对于有可改变危险因素/临床情况的个体，通过药物治疗进行ASCVD的一级预防时，他汀类药物是降低LDL-C水平的一线治疗药物；对于2型糖尿病患者，推荐使用一些在随机对照试验中已证实对ASCVD一级预防有效的特定抗糖尿病药物；对于体重指数≥30 kg/m²（或27 kg/m²且至少有一个ASCVD危险因素或肥胖相关合并症）的肥胖患者，推荐药物治疗以辅助体重管理；血管紧张素转换酶抑制剂、胰高血糖素样肽-1受体激动剂、钠-葡萄糖协同转运蛋白-2抑制剂和非奈利酮可用于慢性肾脏病糖尿病患者的ASCVD一级预防。值得注意的是，由于个体差异、临床实践的多样性以及资源和设施的可用性，医疗保健提供者在临床实践中有充分的决定权。
