剩余的心血管风险:什么时候应该治疗?
Francisco Gomez-Delgado1, Manuel Raya-Cruz2, Niki Katsiki3
1Vascular Risk Unit, Internal Medicine Unit, Jaen University Hospital, Av. del Ejercito Español, 10, PC: 23007, Jaen, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, PC: 28029, Madrid, Spain.
European journal of internal medicine
|October 16, 2023
概括
尽管降低了LDL-c,但残留心血管风险仍然存在. 关键因素包括残留胆固醇,脂蛋白和炎症,新疗法针对这些,以更好地预防心血管疾病.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 预防医学 预防医学
背景情况:
- 心血管疾病 (CVD) 仍然是全球主要的死亡原因.
- 尽管降脂疗法取得了进展,但残留心血管 (CV) 风险导致心血管疾病事件的复发.
- 了解和管理剩余的心血管风险因素对于全面的患者护理至关重要.
研究的目的:
- 审查残留心血管风险的范式.
- 讨论关于CV残留风险因素的管理策略.
- 总结针对特定残留心血管风险因素的新兴和成熟疗法.
主要方法:
- 关于残留心血管风险的当前研究的文献综述.
- 关键决定因素的分析:富含三糖蛋白的脂蛋白 (TRL),残留胆固醇 (RC),脂蛋白 (Lp) 和炎症.
- 评估新的治疗途径和现有治疗方法.
主要成果:
- 确定了主要的残留心血管风险因素:TRL/RC,Lp(a),炎症 (例如hs-CRP),生活方式,污染,血栓风险和代谢风险 (肥胖,T2D).
- 针对apoC-III和ANGPTL3的新兴疗法旨在减少TRL和RC.
- 科尔奇辛在控制炎症和残留心血管风险方面显示出好处;针对Lp (a) 的治疗方法 (ASO,siRNA) 是有希望的.
结论:
- 剩余心血管风险是多因素的,需要针对性的干预措施,除了减少LDL-c.
- 专注于TRL,RC,Lp(a) 和炎症的治疗策略为心血管疾病预防提供了新的途径.
- 管理所有残留心血管风险组件的综合方法对于改善患者的治疗结果至关重要.
相关概念视频
01:26Atherosclerosis III: Management
11
Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
11
01:29Cardiomyopathy V: Interprofessional Care
14
Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
14
01:30Heart Failure V: Medical Management
9
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
9
01:26Coronary Artery Disease IV: Preventive Measures
23
Effective preventive measures for coronary artery disease (CAD) focus on controlling modifiable risk factors, including cholesterol abnormalities and lifestyle changes.Cholesterol ManagementFirst, the Mediterranean diet and the American Heart Association advocate for maintaining low-density lipoprotein (LDL) cholesterol levels below 100 mg/dL, with a more stringent recommendation of below 70 mg/dL for individuals at high risk. LDL cholesterol, often termed "bad cholesterol," can lead to the...
23
01:22Heart Failure VI: Adjunct Therapies
15
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
15
01:27Coronary Artery Disease V: Interprofessional Care
9
Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
9