2013年美国心脏病学会/美国心脏协会成人降胆固醇治疗以降低动脉粥样硬化性心血管风险指南解读

Interpretation of 2013 ACC/AHA guideline in the treatment of blood cholesterol to reduce atheroscle-rotic cardiovascular risk in adults

《2013年美国心脏病学会/美国心脏协会成人胆固醇治疗以降低动脉粥样硬化性心血管风险指南》的重点在于治疗胆固醇以降低动脉粥样硬化性心血管疾病(atherosclerotic cardiovascular diseases,ASCVD)风险。指南专家组成员在所提出的关键问题范围内进行撰写:第一个和第二个关键问题是评价低密度脂蛋白胆固醇和非高密度脂蛋白胆固醇在一级和二级预防中的作用;第三个关键问题是对美国现有的所有降胆固醇药物在降低ASCVD事件有效性和安全性方面的综合评价。针对高质量的随机对照试验(randomized controlled trial,RCT)的系统回顾对哪些人群应用何种强度的治疗方案给出了强有力的证据。有关他汀类药物的RCTs提供了其在减少ASCVD事件方面的最广泛证据。该指南还确定了四大类明确可从他汀类药物治疗中获益的人群。最后,该指南指出,还存在很多缺乏高质量的RCTs证据的临床问题需要参考专家意见来解决,同时指出未来针对这些临床问题希望有更多的RCTs证据以在下一版指南中得以体现。

The2013American College of Cardiology(ACC)/American Heart Association(AHA)guideline focuses on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular diseases(ASCVD)risk in adults.Each expert panel was limited in the number of critical questions(CQs)they could choose.CQ1and CQ2evaluated the evidence for low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol goals in secondary and primary prevention.CQ3was a comprehensive evaluation of the reduction in ASCVD events and safety for each of the cholesterol-lowering drugs available in the United States.The systematic review of evidence from the highest randomized control trial(RCT)with ASCVD outcomes identified strong evidence to indicate who should get which therapy at what intensity.The statin drugs RCTs provide the most extensive evidence for the greatest magnitude of ASCVD event reduction,with the best margin of safety.Identification of4statin benefit groups in which the potential for an ASCVD risk reduction benefit clearly exceeds the potential for adverse effects in adults.Finally,there are many clinical questions for which there is an absence of RCT data available to develop high quality,evidence based recommendations.For these questions,expert opinion may be helpful to clinicians and could be developed in the next iteration of the guideline.