A Modern Approach to Dyslipidemia.
A Modern Approach to Dyslipidemia.
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DOI：
10.1210/endrev/bnab037
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发表时间：
2022-07-13
影响因子：
20.3
通讯作者：
Hegele, Robert A.
中科院分区：
文献类型：
--
作者：
Berberich, Amanda J.;Hegele, Robert A.
涉及血清胆固醇、甘油三酯或两者紊乱的脂质疾病在临床实践中常见，并且通常对心血管风险和整体健康有影响。知识，建议和治疗方案的最新进展需要更新这些疾病的方法。旧的分类方案已经失去了它们的用处，产生了一种方法的基础上确定的原发性血脂紊乱的常规血脂面板作为一个实际的出发点。虽然单基因血脂异常的存在和重要的是要确定，大多数人与脂质障碍有多基因的易感性，往往在第二个因素，如肥胖和2型糖尿病的背景下。关于心血管疾病，低密度脂蛋白胆固醇升高基本上是因果关系，世界各地的临床实践指南已经推荐了该变量的治疗阈值和目标。此外，最近的研究已经确定甘油三酯升高是心血管风险因素，而低密度脂蛋白胆固醇现在似乎比以前认为的贡献更小。更新的诊断和风险评估方法可能包括测量二级脂质变量，如载脂蛋白B和脂蛋白（a），以及选择性使用基因检测来诊断罕见的单基因血脂异常，如家族性高胆固醇血症或家族性乳糜微粒血症综合征。正在进行的开发新的药物，特别是反义RNA和单克隆抗体靶向血脂异常将提供额外的管理选项，这反过来又激发了讨论如何最好地将它们纳入目前的治疗算法。
Lipid disorders involving derangements in serum cholesterol, triglycerides, or both are commonly encountered in clinical practice and often have implications for cardiovascular risk and overall health. Recent advances in knowledge, recommendations, and treatment options have necessitated an updated approach to these disorders. Older classification schemes have outlived their usefulness, yielding to an approach based on the primary lipid disturbance identified on a routine lipid panel as a practical starting point. Although monogenic dyslipidemias exist and are important to identify, most individuals with lipid disorders have polygenic predisposition, often in the context of secondary factors such as obesity and type 2 diabetes. With regard to cardiovascular disease, elevated low-density lipoprotein cholesterol is essentially causal, and clinical practice guidelines worldwide have recommended treatment thresholds and targets for this variable. Furthermore, recent studies have established elevated triglycerides as a cardiovascular risk factor, whereas depressed high-density lipoprotein cholesterol now appears less contributory than was previously believed. An updated approach to diagnosis and risk assessment may include measurement of secondary lipid variables such as apolipoprotein B and lipoprotein(a), together with selective use of genetic testing to diagnose rare monogenic dyslipidemias such as familial hypercholesterolemia or familial chylomicronemia syndrome. The ongoing development of new agents—especially antisense RNA and monoclonal antibodies—targeting dyslipidemias will provide additional management options, which in turn motivates discussion on how best to incorporate them into current treatment algorithms.
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影响因子：
39.3
作者：
Alexander, Veronica J.;Xia, Shuting;Tsimikas, Sotirios
通讯作者：
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作者：
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通讯作者：
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影响因子：
3.1
作者：
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通讯作者：
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