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欧洲脂质指南和心血管风险估计:当前状况和未来挑战
Angela Pirillo1, Lale Tokgözoğlu2, Alberico L Catapano3,4
1Center for the Study of Atherosclerosis, E. Bassini Hospital, Cinisello Balsamo, Milan, Italy.
升高的低密度脂蛋白胆固醇 (LDL-C) 是心血管疾病 (CVD) 的关键驱动因素. 未来的指导方针应该考虑累积的LDL暴露,或"胆固醇年",以更好地评估风险,特别是在年轻人中.
科学领域:
- 心脏病学 心脏病学
- 遗传学 遗传学 是一个
- 流行病学 流行病学
背景情况:
- 低密度脂蛋白胆固醇 (LDL-C) 的升高与动脉样硬化和心血管疾病 (CVD) 有因果关系.
- 目前的欧洲指南 (2019 ESC/EAS) 使用SCORE等风险分层模型来设定LDL-C目标.
研究的目的:
- 审查LDL-C在心血管疾病中的作用,并评估当前的风险评估策略.
- 突出现有模型在鉴定因累积LDL暴露而面临高风险的个体方面的局限性.
主要方法:
- 对LDL-C和CVD的遗传,实验,流行病学和临床数据的审查.
- 对心血管风险评估的SCORE和SCORE2模型的分析.
- 考虑孟德尔的随机化研究和累积LDL暴露的概念.
主要成果:
- SCORE2模型改善了40-69岁个体的10年心血管疾病风险预测.
- 目前的模型可能低估了年轻人患高LDL-C的风险,例如患有家族性高胆固醇血症的人.
- "胆固醇年" (累积的LDL暴露) 的概念越来越重要.
结论:
- 未来的欧洲指南应纳入累积LDL暴露的概念,以更准确地评估心脏病风险.
- 专注于"胆固醇年"可以更好地识别患有早发性心血管疾病高风险的个体,特别是那些终身高高的LDL-C的人.
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