从循证医学到ATPⅢ指南修订:调脂治疗新概念

From Evidence Based Medicine to Revision of NCEP ATP Ⅲ:New Views of Lipid-lowering Treatment

2001年NCEP发表了按循证医学原则制订的胆固醇治疗指南ATPⅢ。此后,有5项他汀类药物临床试验发表,它们论及以前降胆固醇治疗未曾涉及的一些问题。本文回顾这些试验的主要结果,综述了ATPⅢ指南修订的主要补充意见。对于高危者,推荐的治疗目标为LDL-C<2.60mmol/L;对于极高危者,可选择的治疗目标为LDL-C<1.82mmol/L。此目标值亦可用于基线LDL-C<2.60mmol/L的极高危者。对于中度高危者(指有2种或以上危险因子和10年内冠心病危险为10%～20%者),建议LDL-C治疗目标为<3.38mmol/L,但亦可选用LDL-C<2.60mmol/L作为治疗目标。高危或中度高危者,治疗的强度应足以使LDL-C水平至少降低30%～40%。

NCEP ATP Ⅲ was published in 2001 according to the evidence medicine. From then on, 5 important clinical trialsof statins in lipid-lowering treatment have been published. In view of the above, NCEP ATP Ⅲ was revised. The NCEP ATP Ⅲ guidelineswas updated as below. A target of LDL-C<2.60 mmol/L is recommended for individual at high risk of cardiovascular disease, and analternative value of LDL-C<1.82 mmol/L is for very high risk patients. The latter target is also for very high risk patients with baselinevalue of LDL-C<2.60 mmol/L. A target of LDL-C<3.38 mmol/L is suggested for moderate high risk individual (with more than two riskfactors and CHD risk during 10 years is 10% ~ 20%), an alternative value of LDL-C<2.60 mmol/L is also rational. The treatmentintensity should allow to reduce LDL-C level by 30% ~ 40% for high risk and moderate high risk individuals.