2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult
2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult
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DOI：
10.1016/j.cjca.2016.07.510
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发表时间：
2016-11-01
影响因子：
6.2
通讯作者：
Ward, Richard
中科院分区：
文献类型：
--
作者：
Anderson, Todd J.;Gregoire, Jean;Ward, Richard
自2012年指南发布以来，新的文献已经出现，为决策提供了信息。2016年指南主要小组选择了一些临床相关问题，并根据重要的新发现提出了更新的建议。对于临床动脉粥样硬化、腹主动脉瘤患者、大多数糖尿病或慢性肾病患者、低密度脂蛋白胆固醇>= 5 mmol/L的患者，推荐他汀类药物治疗。对于所有其他的，强调与血脂测定相关的风险评估，以优化决策。我们推荐非空腹血脂测定作为空腹水平的合适替代。风险评估和脂质测定应考虑在40岁以上的个体或在那些风险增加，无论年龄。弗雷明汉风险评分（FRS; < 10%）低的患者一般不需要药物治疗。现在有更广泛的FRS中度风险类别（10%-19%）和高FRS（> - 20%）的患者符合他汀类药物治疗的条件。尽管存在争议，但我们继续提倡开始治疗的受试者采用低密度脂蛋白胆固醇靶点。还就所有受试者的健康行为改变提出了详细建议。最后，建议使用非他汀类药物。共同决策是至关重要的，因为在许多领域，临床试验不能完全为实践提供信息。该指南旨在为患者和护理提供者之间提供一个有意义的对话平台，以便为风险筛查、评估和治疗做出个人决定。
Since the publication of the 2012 guidelines new literature has emerged to inform decision-making. The 2016 guidelines primary panel selected a number of clinically relevant questions and has produced updated recommendations, on the basis of important new findings. In subjects with clinical atherosclerosis, abdominal aortic aneurysm, most subjects with diabetes or chronic kidney disease, and those with low-density lipoprotein cholesterol >= 5 mmol/L, statin therapy is recommended. For all others, there is an emphasis on risk assessment linked to lipid determination to optimize decision-making. We have recommended nonfasting lipid determination as a suitable alternative to fasting levels. Risk assessment and lipid determination should be considered in individuals older than 40 years of age or in those at increased risk regardless of age. Pharmacotherapy is generally not indicated for those at low Framingham Risk Score (FRS; < 10%). A wider range of patients are now eligible for statin therapy in the FRS intermediate risk category (10%-19%) and in those with a high FRS (> 20%). Despite the controversy, we continue to advocate for low-density lipoprotein cholesterol targets for subjects who start therapy. Detailed recommendations are also presented for health behaviour modification that is indicated in all subjects. Finally, recommendation for the use of nonstatin medications is provided. Shared decision-making is vital because there are many areas in which clinical trials do not fully inform practice. The guidelines are meant to be a platform for meaningful conversation between patient and care provider so that individual decisions can be made for risk screening, assessment, and treatment.