尽管心血管疾病(CVD)在预防和治疗方面取得了重大进展,但它仍然是全世界导致死亡的主要原因,血脂异常是致动脉粥样硬化性心血管疾病(ASCVD)的关键致病因素,对于2021年度血脂领域的大事件,《国际循环》特邀广东省心血管病研究所黎励文教授进行盘点。
5、年龄<70岁心血管风险高危的健康人群,应考虑将LDL-C降至<1.8 mmol/L(70 mg/dL),且较基线降低50%以上。
(1)LDL-C<1.4 mmol/L(<55 mg/dL)且比基线降低至少50%;
(2)ASCVD患者,若接受最大耐受剂量他汀治疗后2年内发生第二次事件,考虑LDL-C降至<1.0 mmol/L(<40 mg/dL)。
LDL-C<1.8 mmol/L(<70 mg/dL),且比基线降低至少50%。
(4)经过风险获益评估后,也可考虑使用大剂量二十碳五烯酸乙酯。
EPA和DHA补充与降低的心肌梗死风险相关(相对风险[RR],0.87;95%CI:0.80~0.96),需要治疗的高确定性数量NNT=272;
冠心病事件(RR,0.90;95%CI:0.84~0.97),高确定性NNT=192;
致死性心肌梗死(RR,0.65;95% CI:0.46~0.91),中等确定性 NNT=128; 冠心病死亡率(RR,0.91;95% CI:0.85-0.98),低确定性 NNT=431,但不包括CVD事件(RR,0.95;95% CI:0.90~1.00)。
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参考文献(上下滑动查看更多)
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[2] Averna M, Banach M, Bruckert E, et al. Practical guidance for combination lipid-modifying therapy in high- and very-high-risk patients: A statement from a European Atherosclerosis Society Task Force. Atherosclerosis, 2021, 325: 99-109.
[3] 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): 111-88.
[4] Liu HH, Li S, Cao YX, et al. Association of triglyceride-rich lipoprotein-cholesterol with recurrent cardiovascular events in statin-treated patients according to different inflammatory status. Atherosclerosis, 2021, 330: 29-35.
[5] Yoon YH, Ahn JM, Kang DY, et al. Association of Lipoprotein(a) With Recurrent Ischemic Events Following Percutaneous Coronary Intervention. JACC Cardiovasc Interv, 2021, 14(18): 2059-68.
[6] Bernasconi AA, Wiest MM, Lavie CJ, et al. Effect of Omega-3 Dosage on Cardiovascular Outcomes: An Updated Meta-Analysis and Meta-Regression of Interventional Trials. Mayo Clinic proceedings, 2021, 96(2): 304-13.
[7] FDA approves Novartis Leqvio® (inclisiran), first-in-class siRNA to lower cholesterol and keep it low with two doses a year.
(来源:《国际循环》编辑部)
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