2012年美国AACE最新血脂指南

Each year, an estimated 785 000 Americans will have a new coronary artery disease (CAD) event, and approximately 470 000 will have a recurrent attack. CAD caused approximately 1 of every 6 deaths in the United States in 2007. Although rates of stroke are declining, mortality data from 2007 indicate that stroke accounted for 1 of every 18 deaths in the United States. An estimated 33 600 000 adults 20 years or older have total serum cholesterol levels of 240 mg/dL or greater, for a prevalence of 15% of the American population. Dyslipidemia is a primary, major risk factor for CAD and may even be a prerequisite for CAD, occurring before other major risk factors come into play. Epidemiologic data also suggest that hypercholesterolemia and perhaps coronary atherosclerosis itself are risk factors for ischemic stroke. Increasing evidence also points to insulin resistance—which results in increased levels of plasma triglycerides and low-density lipoprotein cholesterol (LDL-C) and a decreased concentration of high-density lipoprotein cholesterol (HDL-C)—as an important risk factor for peripheral vascular disease, stroke, and CAD.

Analysis of 30-year national trends in serum lipid levels shows improvements in total cholesterol and LDL-C levels, which may in part be explained by the steady increase in the use of lipid-lowering drug therapy (self-reported rate of lipid-medication use, 38%). However, 69% of US adults have LDL-C concentrations above 100 mg/dL. Furthermore, the doubling in the prevalence of persons who are obese and the high percentage of patients with elevated triglyceride levels (33%) (and the correlation between obesity and elevated triglycerides) point to the need for continued vigilance on the part of physicians to reduce the risks of cardiovascular disease.

These clinical practice guidelines (CPGs) are for the diagnosis and treatment of dyslipidemia and prevention of atherosclerosis. The mandate for this CPG is to provide a practical guide for endocrinologists to reduce the risks and consequences of dyslipidemia. This CPG extends and updates existing CPGs available in the literature such as the American Association of Clinical Endocrinologists (AACE) Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Dyslipidemia and Prevention of Atherosclerosis and complements the Diabetes Mellitus Comprehensive Care Plan CPG. The landmark National Cholesterol Education Program (NCEP) guidelines serve as the backbone of these lipid recommendations.

These guidelines are unique in that they support the use of apolipoprotein (apo) B or LDL particle number measurements to refine our efforts to achieve effective LDL-C lowering, provide screening recommendations for persons of different ages, and identify special issues for pediatric patients. They also touch on the unique challenges associated with atherosclerosis and heart disease in women. They continue to emphasize the importance of LDL-C lowering and support the measurement of inflammatory markers to stratify risk in certain situations. Finally, an evaluation of the cost-effectiveness of lipid-lowering therapy is presented.

This document is organized into discrete clinical questions, with responses in the Executive Summary and the full guidelines that provide the evidence base supporting these recommendations. The objectives of this CPG are to:

Present an overview of the screening recommendations, assessment of risk, and treatment recommendations for various lipid disorders.

Give special consideration for patients with diabetes, women, and pediatric patients who have dyslipidemia.

Provide cost-effectiveness data to support treatment.

After this prefatory summary, a more in-depth scientific analysis of these issues is presented.