高血脂症治疗之新趋势课件

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1、高血脂症治療之新趨勢成大醫院心臟內科李貽恆NEnglJMed.1997;337:408–416.ImportanceofCholesterolinAtherosclerosisProspectiveCardiovascularMünsterStudyCHDRiskAccordingtoLDLCholesterolIncidence(per1,000in6years)LDLcholesterol177events,4263menaged40-65years163154120TakenfromLipidMetabolism

2、DisordersandCoronaryHeartDisease,G.Assmann,Editor,MMVMedizinVerlag,Munich1993<135<3.5135-1543.5-4.0155-1954.0-5.0>195>5.0(mg/dl)(mmol/L)StepsforEvaluationofHypercholesterolemiaNationalCholesterolEducationProgram(NCEP):TheThirdReportinAdultTreatmentPanel(ATPIII)S

3、tep1DetermineLipoproteinLevelsObtaincompletelipoproteinprofile(totalcholesterol,LDL,HDL,triglyceride)after9-to12-hourfastInalladultsaged20yearsorolder,afastinglipidprofileshouldbeobtainedonceevery5yearsStep2IdentifyPresenceofCHDorCHDRiskEquivalentClinicalCoronary

4、heartdisease(CHD)SymptomaticcarotidarterydiseasePeripheralarterialdiseaseAbdominalaorticaneurysmDiabetesStep3DeterminePresenceofMajorRiskFactorsCigarettesmokingHypertensionLowHDL(<40mg/dl)FamilyhistoryofprematureCHDCHDinmalefirstdegreerelative<55yearsCHDinfemalef

5、irstdegreerelative<65yearsAge(men45years;women55years)HDL60mg/dlcountsasanegativefactorCHDorCHD<100100>100to130riskequivalent†2+riskfactors<130130>130to1600-1riskfactor<160160>160to190NCEPATPIIILDLCholesterolGoalsandTherapyRecommendations*Authoritiesdi

6、sagreeonwhentoinitiatedrugtherapy.†ThiscategoryreferstopatientswithoutclinicallyevidentCHD,butwhohaveasimilarriskforCHDevents(eg,patientswithdiabetes,multipleriskfactors,orotherformsofatheroscleroticdisease,suchasperipheralarterydisease).NCEPATPIIIguidelines.JAMA

7、.2001;285:2486-2497.InitiatetherapeuticlifestylechangesGoalInitiatedrugtherapy*LDLcholesterollevel(mg/dL)CurrenttreatmentguidelineinTaiwanCHDorDMTC200mg/dLorLDL-C130mg/dLGoalTC<160mg/dLorLDL-C<100mg/dL2+RiskFactor:TC200mg/dLorLDL-C130mg/dLGoalTC<200mg/dLorL

8、DL-C<130mg/dL0-1+RiskFactor:TC240mg/dLorLDL-C160mg/dLGoalTC<240mg/dLorLDL-C<160mg/dLRiskFactors:(adaptedfromBNHIlipidtreatmentguideline)HypertensionFamilyhi