JAMA 的一篇文章,作者之一是 JAMA Internal Medicine 的編輯。
64 歲女性被轉到心臟科,因為 total cholesterol 224 mg/dL、HDL-C 107 mg/dL、triglyceride 96 mg/dL、LDL-C 97 mg/dL、Lipoprotein(a) 110 mg/dL,轉診醫師認為應該要用降膽固醇藥物 statin。
病人沒有心血管疾病、沒有家族病史。用 ACC/AHA 的公式計算十年 ASCVD 風險只有 3.6%。
作者認為目前 Lp(a) 的正常值還沒有共識,沒有藥物或非藥物的方法可以下降 Lp(a),也沒有 RCT 證實降低 Lp(a) 可以減少 CVD 風險。
對心血管風險介於要用藥或加強劑量臨界值的病人,Lp(a) 被認為可以當作風險評估的指標之一。不過作者認為目前也沒有好的證據顯示驗 Lp(a) 可以讓 CVD 風險計算的更準。
總之作者認為,在 CVD 風險低的病人驗 Lp(a),是給病人不必要的焦慮、不必要的治療、不必要的轉診、不必要的花費。
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2775380
cvd risk 在 臨床筆記 Facebook 的最佳解答
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Management of Dyslipidemia for Cardiovascular Disease Risk Reduction: Synopsis of the 2020 Updated U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline 2020
• 治療目標是預後(心血管疾病、健康、住院、死亡),而不是血脂濃度。
• 血脂(膽固醇、LDL-C、HDL-C、TG):每 10 年檢驗一次,不需要禁食。
• 初級預防:中度劑量的 statins,不要用 PCSK9 抑制劑。高危險群者能加上地中海飲食。
• 次級預防:中度劑量的 statins,高危險群(AMI 之後、ACS 一年內、復發性 AMI/ACS/中風、糖尿病、抽煙、PAOD、PCI、CABG)病人可以用高強度 statins、加上 ezetimibe/PCSK9 抑制劑、禁食 TG > 150 mg/dL(非禁食 TG > 200 mg/dL)者能加上 VASCEPA(Icosapent Ethyl)、地中海飲食。
• 沒有幫助:CAC、CRP、ABI、apolipoproteins。
• 不要用 niacin、fibrates。
Lipitor (atorvastatin 10-20 mg/tablet), Crestor (rosuvastatin 10 mg/tablet).
1. Continue to Treat to Target Dose Not LDL-C Level
2. Use of Additional Tests to Refine Risk Prediction: Evidence Is Still Insufficient
coronary artery calcium (CAC), high-sensitivity C-reactive protein, ankle–brachial index, and apolipoprotein
3. Primary Prevention: Moderate-Dose Statin Therapy Is Still Emphasized; No to Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors
No RCT directly compared high-dose with moderate-dose statin therapy in primary prevention.
4. Secondary Prevention: Moderate Statin Doses Initially, Then Stepped Intensification in Higher-Risk Patients
For higher-risk patients (recent MI or acute coronary syndrome (in the past 12 months); recurrent acute coronary syndrome, MI, or stroke; or established CVD with additional major risk factors (such as current tobacco use, diabetes, peripheral artery disease, or previous coronary artery bypass graft surgery or percutaneous coronary intervention), evidence supports the addition of ezetimibe or PCSK9 inhibitors to moderate- or high-dose statin therapy.
5. Laboratory Testing: No Routine Fasting or Monitoring Is Needed; Less Is More
We recommend measuring lipid levels no more than every 10 years. Note that previously measured lipid levels may be used reliably in serial CVD risk assessments. We do not recommend rechecking lipid levels each time CVD risk is assessed, because lipid levels remain stable within each patient over time and contribute little to predicted risk relative to other factors.
6. Physical Activity: Increased Aerobic Exercise for All and Cardiac Rehabilitation After a Recent CVD Event
7. Nutrition, Supplements, Niacin, and Fibrates: Suggest a Mediterranean Diet for High-Risk Patients, Limit Icosapent Ethyl to Secondary Prevention, Avoid Supplements and Niacin, and Avoid Adding Fibrates to Statin Therapy
https://www.acpjournals.org/doi/full/10.7326/M20-4648
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In a study published Monday in the journal Heart, researchers from the University Hospital of Lausanne in Switzerland detailed the results from their study on the relationship between napping frequency/average nap time and the risk of fatal and nonfatal cardiovascular disease (CVD).
瑞士洛桑大學醫院的研究人員週一發表在《心臟》期刊上的一項研究中,詳細介紹他們對小睡頻率/平均小睡時間,與致命性和非致命性心血管疾病(CVD)風險之間關係的研究結果。
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