Use of Lipid-Lowering Drugs After Intracerebral Hemorrhage.
Use of Lipid-Lowering Drugs After Intracerebral Hemorrhage.
复制标题
脑出血后降脂药物的使用
作者：
高血压在脑出血（ICH）患者中常见。越来越多的证据表明，ICH患者存在未来出血复发、心血管疾病和缺血性卒中的风险，并强调了ICH后血管事件二级预防的重要性。虽然高脂血症强化治疗在减少缺血性卒中患者缺血性心脏和血管事件方面的获益已得到充分证实，但ICH患者的获益与危害尚不清楚。流行病学研究表明，高脂血症对ICH具有保护作用，并且强化降脂与ICH风险增加相关。同样，虽然目前可用的降脂治疗已在缺血性心脏和血管疾病患者中进行了全面研究，但这些治疗的随机试验仅包括极少数有ICH病史的患者。因此，限制了关于这些治疗在ICH人群中的安全性和净获益的任何明确结论。目前，关于ICH后高脂血症管理的最佳策略尚未达成共识。在这篇文章中，我们回顾了相关文献，概述了降脂治疗在这一脆弱患者群体中的竞争风险和益处。我们根据现有数据提出了一种治疗模式，但需要注意的是，需要专门的随机试验数据来建立必要的证据，以指导有ICH病史的患者的最佳降脂策略。
Hyperlipidemia is common in patients with intracerebral hemorrhage (ICH). Accumulating evidence indicates that patients with ICH are at risk for future hemorrhage recurrence, cardiovascular disease, and ischemic stroke, and highlights the importance of secondary prevention of vascular events after ICH. While the benefits of intensive treatment of hyperlipidemia for reducing ischemic cardiac and vascular events in patients with ischemic stroke are well established, the benefit vs. harm in patients with ICH are less clear. Epidemiological studies suggest that hyperlipidemia is protective against ICH and that intensive lowering of lipids is associated with increased risk for ICH. Similarly, while currently available lipid-lowering treatments have been thoroughly studied in patients with ischemic cardiac and vascular disease, only few randomized trials of these therapies included a very small number of patients with history of ICH. Thus, limiting any definitive conclusions regarding the safety and net benefit of these treatments in ICH populations. Currently, there is no consensus regarding the optimal strategy for management of hyperlipidemia after ICH. In this article, we review relevant literature to outline the competing risks and benefits of lipid lowering treatments in this vulnerable patient population. We suggest a treatment paradigm based on available data, but note that data from dedicated randomized trials are needed to build the necessary evidence to guide optimal lipid-lowering strategy in patients with a history of ICH.