中国血脂管理指南(2023年)

Chinese Guidelines for Lipid Management(2023)

以动脉粥样硬化性心血管疾病(atherosclerotic cardiovascular disease,ASCVD)为主的心血管疾病(cardiovascular disease,CVD)是我国城乡居民第一位死因,低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)是ASCVD的致病性危险因素。面对我国ASCVD疾病负担不断上升的趋势,血脂管理刻不容缓。近几年世界范围内血脂领域的研究取得了突破性进展,我国血脂指南的修订势在必行。由于人群血脂合适水平随ASCVD危险分层的级别不同而异,在没有危险因素的人群中,所谓“正常”的LDL-C水平对ASCVD超(极)高危患者而言则属明显升高。因此,指南修订专家委员会经认真讨论后,决定将“血脂异常防治指南”修改为“血脂管理指南”(以下简称新指南)。新指南仍推荐LDL-C作为血脂干预的首要靶点,以危险分层确定其目标值。推荐在生活方式干预的基础上,以中等强度他汀类药物作为起始药物治疗,必要时联用胆固醇吸收抑制剂或(和)前蛋白转化酶枯草溶菌素9抑制剂的达标策略。新指南涵盖了从儿童到老年全生命周期的血脂管理建议。旨在通过本指南指导临床实践,全面提升我国血脂管理水平,推进ASCVD防治。

In China,atherosclerotic cardiovascular disease(ASCVD)is the leading cause of death among urban and rural residents,and low-density lipoprotein cholesterol(LDL-C)is the pathogenic risk factor of ASCVD.In face of the rising burden of ASCVD in China,lipid management is of urgent importance.In light of the research breakthroughs on blood lipids around the world in recent years,it is imperative to revise Chinese guidelines on blood lipid management.Because the appropriate lipid levels vary in people with different ASCVD risks,certain LDL-C levels which are considered normal in people without risk factors should be regarded as elevated in people with super high(very high)risk of ASCVD.Therefore,after careful discussion,the expert committee on guideline revision decided to change the"Guidelines on Prevention and Treatment of dyslipidemia"into the"Guidelines for Lipid Management"(hereinafter referred to as the new guidelines).The new guidelines still recommend using LDL-C as the primary target for lipid intervention,and determining target LDL-C values according to risk stratification.For reaching the target value,it is recommended that,on the basis of lifestyle intervention,moderate intensity statin therapy should be used as the initial drug treatment option,and cholesterol absorption inhibitors and/or proprotein convertase subtilisin kexin 9 inhibitors should be combined when necessary.The new guidelines cover lipid management throughout the life cycle,from children to the elderly.The aim of the new guidelines is to improve blood lipid management in China in all aspects for better prevention and treatment of ASCVD by guiding clinical practice of lipid management.