[低胆固醇和极低胆固醇水平:我们需要知道什么]。

IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
Stefania Angela Di Fusco, Massimo Leggio, Vered Gil Ad, Simona Giubilato, Stefano Aquilani, Federico Nardi, Massimo Grimaldi, Domenico Gabrielli, Fabrizio Oliva, Giuseppe Imperoli, Furio Colivicchi
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引用次数: 0

摘要

由于越来越多的证据表明降低低密度脂蛋白胆固醇(LDL-C)水平可带来临床益处、多种有效降脂药物的可用性以及指南建议,临床医生经常需要管理低密度脂蛋白胆固醇(LDL-C)水平较低或非常低的患者。在临床实践中,必须考虑到当低密度脂蛋白胆固醇(LDL-C)血浆浓度较低时,通常用于计算 LDL-C 水平的弗里德瓦尔德公式的准确性较低,因此应采用不同的 LDL-C 水平定量方法综合进行风险评估,并测量其他参数,如非高流脂蛋白胆固醇,以及在可能的情况下测量脂蛋白 B。至于低 LDL-C 水平的临床影响,除了极低或检测不到 LDL-C 水平的低胆固醇血症外,由基因决定的低胆固醇血症都提供了令人放心的长期影响数据。使用高效降脂药物(如 Prorotein convertase subtilisin/kexin type 9 抑制剂)进行的临床研究也提供了相同的证据。在这些研究中,达到极低 LDL-C 水平的患者非心血管不良事件的发生率与安慰剂组相似。总之,在有降低心血管事件风险的指征时,对不良反应的恐惧不应阻碍强化降脂治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Low and very low cholesterol levels: what we need to know].

Due to the growing evidence of clinical benefits conferred by the reduction of low-density lipoprotein cholesterol (LDL-C) levels, the availability of multiple effective lipid-lowering agents, and guideline recommendations, clinicians not infrequently have to manage patients with low or very low LDL-C levels. In clinical practice it is essential to consider that, when LDL-C plasma concentrations are low, the Friedewald formula commonly used for LDL-C level calculation is less accurate, hence risk assessment should be integrated by using different methods for LDL-C level quantification and other parameters, such as non-high-density lipoprotein cholesterol and, where possible, apolipoprotein B, should be measured. As regards the clinical impact of low LDL-C levels, genetically determined hypocholesterolemia forms provide reassuring data on the effects of this condition in the long term, except for the forms with extremely low or undetectable LDL-C levels. Evidence from clinical studies that used highly effective lipid-lowering drugs, such as proprotein convertase subtilisin/kexin type 9 inhibitors, goes in the same direction. In these studies, the incidence of non-cardiovascular adverse events in patients who reached very low LDL-C levels was similar to that in the placebo arm. Overall, the fear of adverse effects should not deter intensive lipid-lowering treatment when indicated to reduce the risk of cardiovascular events.

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Giornale italiano di cardiologia
Giornale italiano di cardiologia CARDIAC & CARDIOVASCULAR SYSTEMS-
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