Management of dyslipidemia in adults.
Management of dyslipidemia in adults.
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发表时间：
1998-05
影响因子：
4
通讯作者：
S. M. Ahmed;M. Clasen;John F. Donnelly
中科院分区：
文献类型：
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作者：
S. M. Ahmed;M. Clasen;John F. Donnelly
国家胆固醇教育计划指南强调了基于心血管危险因素治疗血脂异常的重要性。评估的第一步是排除高脂血症的次要原因。评估患者患冠心病的风险有助于确定应开始哪种治疗以及应多久进行一次血脂分析。对于冠心病的一级预防，治疗目标是使只有一个危险因素的患者的低密度脂蛋白（LDL）胆固醇水平低于160 mg/dL（4.15 mmol/L）。有两个或两个以上危险因素的患者的目标LDL水平为130 mg/dL（3.35 mmol/L）或更低。对于有冠心病记录的患者，LDL胆固醇水平应降低至100 mg/dL（2.60 mmol/L）以下。第二步饮食，其中总脂肪含量低于总热量的30%，饱和脂肪占总热量的8%至10%，可能有助于将某些患者的LDL胆固醇水平降低到目标范围。高纤维饮食也有治疗作用。最常用的血脂异常药物治疗包括胆汁酸结合树脂、HMG-CoA还原酶抑制剂、烟酸和纤维酸衍生物。在某些情况下，其他可能的治疗方法是雌激素替代疗法，血浆置换术，甚至在严重的难治性病例中进行手术。
The importance of treating dyslipidemias based on cardiovascular risk factors is highlighted by the National Cholesterol Education Program guidelines. The first step in evaluation is to exclude secondary causes of hyperlipidemia. Assessment of the patient's risk for coronary heart disease helps determine which treatment should be initiated and how often lipid analysis should be performed. For primary prevention of coronary heart disease, the treatment goal is to achieve a low-density lipoprotein (LDL) cholesterol level of less than 160 mg per dL (4.15 mmol per L) in patients with only one risk factor. The target LDL level in patients with two or more risk factors is 130 mg per dL (3.35 mmol per L) or less. For patients with documented coronary heart disease, the LDL cholesterol level should be reduced to less than 100 mg per dL (2.60 mmol per L). A step II diet, in which the total fat content is less than 30 percent of total calories and saturated fat is 8 to 10 percent of total calories, may help reduce LDL cholesterol levels to the target range in some patients. A high-fiber diet is also therapeutic. The most commonly used options for pharmacologic treatment of dyslipidemia include bile acid-binding resins, HMG-CoA reductase inhibitors, nicotinic acid and fibric acid derivatives. Other possibilities in selected cases are estrogen replacement therapy, plasmapheresis and even surgery in severe, refractory cases.