医学
以兹提米比
内科学
烟酸
血脂异常
他汀类
类降脂药
内分泌学
疾病
糖尿病
动脉粥样硬化性心血管疾病
胃肠病学
作者
Yehuda Handelsman,Paul S. Jellinger,Chris Guerin,Zachary T. Bloomgarden,Eliot A. Brinton,Matthew J. Budoff,Michael H. Davidson,Daniel Einhorn,Sergio Fazio,Vivian Fonseca,Alan J. Garber,George Grunberger,Ronald M. Krauss,Jeffrey I. Mechanick,Paul D. Rosenblit,Donald A. Smith,Kathleen Wyne
摘要
The treatment of lipid disorders begins with lifestyle therapy to improve nutrition, physical activity, weight, and other factors that affect lipids. Secondary causes of lipid disorders should be addressed, and pharmacologic therapy initiated based on a patient’s risk for atherosclerotic cardiovascular disease (ASCVD). Patients at extreme ASCVD risk should be treated with high-intensity statin therapy to achieve a goal low-density lipoprotein cholesterol (LDL-C) of <55 mg/dL, and those at very high ASCVD risk should be treated to achieve LDL-C <70 mg/dL. Treatment for moderate and high ASCVD risk patients may begin with a moderate-intensity statin to achieve an LDL-C <100 mg/dL, while the LDL-C goal is <130 mg/dL for those at low risk. In all cases, treatment should be intensified, including the addition of other LDL-C-lowering agents (i.e., proprotein convertase subtilisin/kexin type 9 inhibitors, ezetimibe, colesevelam, or bempedoic acid) as needed to achieve treatment goals. When targeting triglyceride levels, the desirable goal is <150 mg/dL. Statin therapy should be combined with a fibrate, prescription-grade omega-3 fatty acid, and/or niacin to reduce triglycerides in all patients with triglycerides ≥500 mg/dL, and icosapent ethyl should be added to a statin in any patient with established ASCVD or diabetes with ≥2 ASCVD risk factors and triglycerides between 135 and 499 mg/dL to prevent ASCVD events. Management of additional risk factors such as elevated lipoprotein(a) and statin intolerance is also described.
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