作者:张云盛 来源:医学界心血管频道
特别提醒: 在服用他汀类药物期间出现肌肉不适或无力症状以及排褐色尿时,应及时监测CK! 如果已确诊有ASCVD(冠心病、脑卒中、外周血管病等),即使血脂正常也不能停药。 ASCVD的病理基础是动脉粥样硬化,是脂代谢紊乱和炎症性血管疾病,他汀类药物具有调脂和抑制炎症作用,临床试验已证明他汀可以稳定斑块(减少斑块破裂形成血栓风险),甚至逆转斑块,显著降低心血管事件! 获益大于风险是临床中的他汀治疗原则。 他汀具有一定的肝毒性和肌毒性。临床在选用他汀治疗时应尽可能考虑患者情况,选择合适的他汀种类和剂量。同时,要特别注意他汀与其他药物之间的相互作用。 [1]中国成人血脂异常防治指南修订联合委员会.中国成人血脂异常防治指南(2016年修订版)[J].中华心血管病杂志,2016,44(10):833-853. [2]中华医学会心血管病学分会动脉粥样硬化与冠心病学组,中华心血管病杂志编辑委员会.超高危动脉粥样硬化性心血管疾病患者血脂管理中国专家共识[J].中华心血管病杂志,2020,48(4):280-286. [3]叶平,王晓娜.从百年胆固醇学说到新型降脂药物[J].中国循环杂志,2016,31(1):1-3. [4]Martin Bødtker Mortensen,et al.Elevated LDL cholesterol and increased risk of myocardial infarction and atherosclerotic cardiovascular disease in individuals aged 70–100 years:a contemporary primary prevention cohort.Lancet,November 10,2020. [5]Baris Gencer,et al.Efficacy and safety of lowering LDL cholesterol in older patients:a systematic review and meta-analysis of randomised controlled trials.Lancet,November 10,2020. [6]叶平.关注超高危ASCVD患者LDL-C达标降脂药物联合应用是大势所趋[J].中华心血管 [7]中国胆固醇教育计划(CCEP)工作委员会,中国医疗保健国际交流促进会动脉粥样硬化血栓疾病防治分会,中国老年学和老年医学学会心血管病分会,中国医师协会心血管内科医师分会动脉粥样硬化专业委员会.中国胆固醇教育计划调脂治疗降低心血管事件专家建议(2019)[J].中华内科杂志,2020,59(1):18-22. [8]Stephen J. Nicholls; JAMA. 2007; 297(5): 499-508. [9]Nissen SE, et al. JAMA. 2004; 291: 1071-1080. [10]他汀类药物安全性评价工作组.他汀类药物安全性评价专家共识[J].中华心血管病杂志,2014,42(11):890-894. [11]赵水平.中国他汀安全性评价专家共识重点解析[J].浙江医学,2014,(24):1971-1972. [12]2018AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation [13]Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J, 2020, 41(1): 111-188. [14]Chaoran Ma, M. Edip Gurol, Zhe Huang, et al.(2019). Low-density lipoprotein cholesterol and risk of intracerebral hemorrhage Neurology, 10.1212/WNL.0000000000007853 [15]Low LDL Cholesterol and Hemorrhagic Stroke. Retrieved July 3, 2019, from https://www./neurology/strokes/80827 [16]Cholesterol that is too low may boost risk for hemorrhagic stroke. Retrieved July 3, 2019, from https:///news/2019-07-cholesterol-boost-hemorrhagic.html [17]Maki KC, Ridker PM, Brown WV, Grundy SM, Sattar N, The Diabetes Subpanel of the National Lipid Association Expert Panel. An assessment by the Statin Diabetes Safety Task Force: 2014 update. J Clin Lipidol. 2014 May-Jun;8(3 Suppl):S17-29. doi: 10.1016/j.jacl.2014.02.012. PMID: 24793439. |
|