新时期降脂预防心血管疾病:联合治疗的实用途径:降脂与联合治疗

E. Michos, K. Ferdinand
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引用次数: 4

摘要

低密度脂蛋白-胆固醇(LDL-C)是动脉粥样硬化性心血管疾病(ASCVD)发生和发展的主要病因,降低LDL-C是ASCVD治疗和预防的核心原则。此外,ASCVD风险的降低与LDL-C的降低程度成正比。最近的欧洲指南建议心血管风险极高的患者的目标为<55 mg/dL (<1.4 mmol/L),而美国指南认为LDL-C≥70 mg/dL(≤1.8 mmol/L)是加强治疗的阈值,在他汀类药物的基础上增加非他汀类药物治疗。为了达到<55 mg/dL或<70 mg/dL的较低LDL-C目标,大多数患者需要联合治疗。药物组合,特别是单片组合,可能会大大增加对治疗的依从性。坚持治疗对于获得临床益处至关重要,由于许多患者停药,长期坚持降脂治疗是ASCVD预防的一个主要问题。二级预防或高危一级预防患者,如家族性高胆固醇血症患者,其最大耐受他汀类药物剂量不能充分降低LDL-C,可从联合治疗中获益。在目前的临床实践中,他汀类药物联合依泽替米、他汀类药物加PCSK9抑制剂(加或不加依泽替米),以及最近他汀类药物或依泽替米加苯甲多酸是最常用的降低ldl - c的联合疗法。这篇综述概述了使用联合治疗实现LDL-C治疗的重要性
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Lipid-lowering for the prevention of cardiovascular disease in the new era: A practical approach to combination therapy: Lipid-lowering and combination therapy
Low density lipoprotein-cholesterol (LDL-C) is the main etiologic factor for the development and progression of atherosclerotic cardiovascular disease (ASCVD) and LDL-C reduction is a central tenet of ASCVD treatment and prevention. Moreover, ASCVD risk reduction is proportional to the magnitude of LDL-C lowering. Recent European guidelines have recommended a goal of <55 mg/dL (<1.4 mmol/L) for patients at very-high cardiovascular risk, while the U.S. guideline considers an LDL-C ≥70 mg/dL (≤1.8 mmol/L) as a threshold to intensify therapy with the addition of a non-statin therapy to statins. To reach these lower LDL-C goals of <55 mg/dL or <70 mg/dL, combination therapy is necessary in the majority of these patients. Drug combinations, and in particular single-pill combinations, may substantially increase adherence to therapy. Adherence is essential for achieving a clinical benefit and, as many patients discontinue medications, the long-term adherence to lipid-lowering therapy represents a major issue in ASCVD prevention. Secondary prevention or high-risk primary prevention patients, such as those with familial hypercholesterolemia in whom maximally-tolerated statin doses alone would not be anticipated to sufficiently lower LDL-C, would benefit from combination therapy. In current clinical practice, statins with ezetimibe, statins plus PCSK9 inhibitors (with or without ezetimibe), and, most recently statins or ezetimibe with bempedoic acid are the most commonly used combination therapies for LDL-C-lowering. This review outlines the importance of using combination therapy for the achievement of LDL-C treatment
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