预防中风的失脂症管理:个性化的方法
Maria-Ioanna Stefanou1,2, Evangelos Panagiotopoulos1, Evangelos Liberopoulos3
1Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
概括
脑卒中失脂症的治疗正在将重点转移到阿波利波蛋白B和脂质蛋白上. 根据中风类型而定制降脂策略,而不仅仅是LDL-C,可以改善结果.
科学领域:
- 心血管医学 心血管医学
- 神经学 神经学
- 药理学 药理学是指药理学的学科.
背景情况:
- 脱脂症是中风的关键危险因素,阿波利波蛋白B (ApoB) 和脂蛋白[Lp]提供比单独的LDL-C更好的风险评估.
- 目前的中风脂质管理通常使用统一的目标,忽视中风病因和亚型特定需求.
研究的目的:
- 审查目前关于各种中风亚型中脂质管理的证据.
- 提出一种以表型为指导的个性化框架,用于中风患者的失脂症管理.
主要方法:
- 综合目前关于降脂疗法及其在不同类型中风中的疗效的证据.
- 对新出现的脂质标的分析,包括ApoB,Lp(a) 和甘油三.
- 考虑特定的患者群体,如脑内出血 (ICH) 患者.
主要成果:
- 强烈的LDL-C降低有效降低了复发性缺血性中风风险.
- 新的药物,如PCSK9抑制剂,inclisiran和bempedoic酸提供强大的LDL-C降低.
- 降低Lp (a) 的疗法和icosapent乙烯对分别降低残留风险和预防IS有希望.
- 在ICH中,脂质管理需要平衡缺血和出血风险,特别考虑叶状ICH和脑粉样血管病变 (CAA).
结论:
- 根据中风病因量身定制的个性化,表型导向的脂质管理对于优化结果至关重要.
- 超越统一的脂质标,转向病因和基因相关的策略,可以完善中风预防和改善患者护理.
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