2013年美国成年人胆固醇治疗指南的更新与局限

The update and limitation of 2013 ACC/AHA guideline on the treatment of blood cholesterol in adults

2013年ACC/AHA胆固醇治疗指南聚焦他汀降低动脉粥样硬化性心血管疾病(ASCVD)事件,定义了4类他汀获益人群。新指南依据随机临床试验证据,没有设定ASCVD一级预防和二级预防中LDL-C或非HDL-C治疗目标值,推荐了降低LDL-C的他汀治疗强度与优化治疗,对他汀以外降脂药物的推荐淡化。然而,血清胆固醇管理是一个漫长过程,需要他汀治疗LDL-C的起始值和目标值,高危人群他汀治疗可以采取短期强化、长期优化、过程简化的策略。

The 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol in Adults focused on the atherosclerotic cardiovascular disease （ASCVD） events reduction from statins, and identified 4 major stalin benefit groups. Evidence-based on randomized controlled trials （RCTs）, the panel made no recommendations for LDL-C or non-HDL-C targets for the primary or secondary prevention of ASCVD. The expert panel recommended the intensity of statin therapy and optimizing statin therapy, and reduced the other lipidlowering drugs of nonstatins. However, the cholesterol management is a very long process, and need to define the initiating and targeting value for reducing LDL-C. The high risk group might take the strategy of statins treatment on short term intensity, long term optimizing and process simplify.