风险评估和管理的进展:预测更新跨越国际胆固醇指南
Alexander C Razavi1,2, Mark Sokolsky2, Matthew Belanger2
1Emory Center for Heart Disease Prevention, Emory University School of Medicine, Atlanta, GA, USA.
American journal of preventive cardiology
|February 2, 2026
概括
新的胆固醇指南将包括更新的ASCVD风险方程和较低的值. 实现较低的LDL-C目标可能需要多种降脂药物,包括高风险患者的PCSK9抑制剂.
科学领域:
- 心脏病学 心脏病学
- 预防医学 预防医学
- 药理学 药理学是指药理学的学科.
背景情况:
- 全球胆固醇指南正在进行更新,需要对最近的证据进行审查.
- 准确的动脉样硬化心血管疾病 (ASCVD) 风险估计对于脂质管理和治疗决策至关重要.
- 现有的风险评估工具,如聚合队列方程,可能会被新的模型所取代.
研究的目的:
- 审查影响风险评估和脂质管理的证据,预期新的全球胆固醇指南.
- 突出风险分层的进展和降低低密度脂蛋白胆固醇 (LDL-C) 的治疗策略.
- 为临床医生提供有关初级和二级ASCVD预防的最佳方法的信息.
主要方法:
- 审查自美国和欧洲最后一次主要指南代以来发表的科学文献和证据.
- 分析新兴的风险评估工具,包括PREVENT方程和冠状动脉 (CAC) 评分.
- 评估当前和新兴的降脂疗法,包括组合疗法和PCSK9抑制剂.
主要成果:
- 预计更新的指南将纳入PREVENT方程,可能建立较低的ASCVD风险值.
- 冠状动脉 (CAC) 评分提供了比传统因素更好的风险预测,指导药物使用和LDL-C目标.
- 达到目标的LDL-C水平,特别是在高危人群中,往往需要联合治疗 (例如,他类药物与ezetimibe或bempedoic酸) 或PCSK9抑制剂.
- 非常高风险的患者可能会从治疗中受益,LDL-C水平低于30 mg/dL,具有显著的ASCVD风险降低和良好的安全性.
- 升高的脂蛋白 (Lp) [Lp) ]可能会识别出那些可以从PCSK9抑制剂中获得更大的益处的患者,而这些患者正在等待特定的Lp (a) 向治疗.
结论:
- 基于ASCVD风险的方法仍然是制定LDL-C目标的基础.
- 在高风险和非常高风险人群中,经常需要多种降脂药物来实现最佳的LDL-C降低.
- 新出现的证据支持积极降低LDL-C,甚至降低到非常低的水平,以大幅降低ASCVD风险.
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