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[APCC2011]全面血脂干预是否带来更多心血管获益?
美国加州大学欧文分校医学院Nathan Wong 教授专访
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 编辑:国际循环网 时间:2011/6/20 10:01:55    加入收藏
 关键字:血脂干预 LDL-C 甘油三酯 

    We are very well aware that despite improved control of LDL-C many individuals still suffer coronary heart disease events. A large reason for this is that other lipid profile components are not adequately addressed by most physicians. As a result, we are seeing in our national data that overall less than 20% of individuals in the United States are controlled to target for LDL-C, HDL-C, and triglycerides so there is a significant opportunity for us to address these other lipid fractions.
The National Cholesterol Education Program (NCEP) as well as others have recently put more emphasis on non-HDL-C because this captures all of the atherogenic lipoproteins. It is possible for people to be on target for LDL-C but not non-HDL-C where the goals are 30 points higher than that of LDL-C. Therefore, in a high-risk patient, where we would normally want to see the LDL-C below 100 mg/dl with an optional goal of less than 70 mg/dl, we would want to see the non-HDL-C goals 30 points higher than that.
    There is increased attention and we are widely awaiting the results from important trials that involve combination therapy with agents such as statins and niacin to see whether the improvement that you get in the other lipoprotein fractions, namely HDL-C and triglycerides, over that of a statin alone will result in incremental risk reduction.


    我们非常清楚,尽管改善了对LDL-C的控制,很多人仍发生冠心病事件。很大原因就是大部分内科医生没有充分控制其它脂质成分。因此,我们在国家调查数据上看到,总体上美国不到20%的人将LDL-C、 HDL-C和甘油三酯作为控制靶点,因此,我们有很大的机会来控制这些其他的脂质成分。国家胆固醇教育计划(NCEP)和其他文件近来进一步强调non-HDL-C,因为后者与所有致动脉粥样硬化的脂蛋白结合。人们可能LDL-C达标了,而non-HDL-C没达标,后者目标较LDL-C高30 mg/dl。因此,在高危患者,我们通常想看到LDL-C低于100 mg/dl,理想目标低于70 mg/dl,non-HDL-C目标较之高30 mg/dl。大家越来越关注联合疗法,如联用他汀和烟酸改善其他脂质成分如HDL-C和甘油三酯是否较单用他汀能更多地降低风险。
 

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