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【論文摘要】2016 Chinese Guidelines for the Management of Dyslipidemia in Adults
摘要
Over the last 30 years, the blood lipid level in the Chinese population has gradually increased, and the incidence of dyslipidemia has significantly increased. A nationwide survey in 2012 showed that the average serum total cholesterol (TC) value in adults was 4.50 mmol/L and that the prevalence of hypercholesterolemia was 4.9%; the average value of triglyceride (TG) was 1.38 mmol/L, and the prevalence of hypertriglyceridemia was 13.1%; the average value of high-density lipoprotein cholesterol (HDL-C) was 1.19 mmol/L, and the prevalence of HDL-C hypolipidemia was 33.9%. The overall prevalence of dyslipidemia among Chinese adults reached 40.4%, which has substantially increased since 2002. The increase of serum cholesterol level in the population will increase by approximately 9.2 million cases of cardiovascular events in China between 2010 and 2030. The prevalence of hypercholesterolemia among Chinese children and adolescents is also significantly increasing, suggesting that the development of dyslipidemia and the relevant disease burdens in Chinese adults will continue to increase. (The form abridges) If the baseline value of LDL-C is high, then LDL-C is difficult to reduce to the basic target value after treatment with the existing standard lipid-lowering treatment for 3 months. Thus, the alternative goal of at least 50% reduction of LDL-C should be considered (Class IIa recommendation, Level B evidence). In the clinic, the LDL-C baseline values of certain very-high-risk patients are already within the basic target values. At this time, LDL-C can be reduced by approximately 30% from the baseline value (Class I recommendation, Level A evidence). The target value of non-HDL-C is higher than that of LDL-C by 0.8 mmol/L (30 mg/dl). The target values of non-HDL-C treatment in populations at different risks are shown in Table 4 (Class I recommendation, Level B evidence). The use of medium-intensity statins is recommended for initial treatment. The dose is properly adjusted according to individual lipid-lowering efficacy and tolerance conditions. If the cholesterol level does not reach the target, then other lipid-lowering drugs (e.g., ezetimibe) can be used in combination to obtain safe and effective lipid-lowering effects (Class I recommendation, Level B evidence). The appropriate level of serum TG is ＜1.7 mmol/L (150 mg/dl). When serum TG is ≥1.7 mmol/L (150 mg/dl), non-drug intervention measurement is first applied including therapeutic diet, reduction of body weight, and abstinence from alcohol. If the TG level only shows a mild-to-moderate increase (i.e., 2.3~5.6 mmol/L [200~500 mg/dl]) to manage the risk of ASCVD, then although the reduction of the LDL-C level is the major goal, non-HDL-C should also reach the target value. If non-HDL-C cannot reach the target value even after statin therapy, then fibrates and high purity fish oil preparations should be used additionally with statins. For patients with severe hypertriglyceridemia and fasting TG levels of ≥5.7 mmol/L (500 mg/dl), drugs that reduce TG and VLDL-C should be considered first (e.g., fibrates, high purity fish oil preparations, or niacin).