在患有慢性脏病的患者中管理失脂血症
1Department of Cardiology, Sir Ganga Ram Hospital, New Delhi, 110060, India.
Indian heart journal
|January 26, 2024
概括
在大多数慢性病 (CKD) 患者中,他类药物和ezetimibe有效降低心血管风险. 然而,对于没有确定的动脉样硬化心血管疾病 (ASCVD) 的血液透析患者,不建议启动降脂疗法.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 患有慢性病 (CKD) 的患者面临心血管事件的风险增加.
- 临床证据表明,他类药物可以降低慢性病患者的全因死亡率和心血管事件.
研究的目的:
- 审查CKD患者的降脂疗法的当前建议.
- 为了澄清在CKD管理中适当使用他类药物,埃泽蒂米布和其他脂质调节剂.
主要方法:
- 对临床研究和关于CKD中脂质管理的指导方针的审查.
- 关于在CKD患者中使用他类药物,ezetimibe,纤维酸和PCSK9抑制剂的证据分析,这些患者的功能程度和ASCVD状态各不相同.
主要成果:
- 大多数CKD患者的eGFR<60毫升/分钟或albuminuria (≥3毫克/毫升) 建议使用他类药物+/-ezetimibe降脂疗法.
- 对于没有确定的ASCVD的血液透析患者,不建议启动他类药物治疗,但如果已经在治疗中,特别是在ASCVD的情况下,建议继续治疗.
- 纤维酸不应与他类药物联合使用;不建议以泽提作为单一疗法.
结论:
- 降脂疗法,特别是他类药物,在控制CKD中心血管风险方面发挥着至关重要的作用.
- 仔细考虑患者的状况,包括透析依赖和ASCVD的存在,对于CKD的最佳脂质管理至关重要.
- PCSK9抑制剂在减少LDL胆固醇而没有对脏产生不良影响方面显示出有前景,因此需要进一步调查.
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