關於 high ankle-brachial index ，我們在網路上蒐集到這些相關的討論、資訊與評價

#lipid #gdl
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

年齡、性別、高血壓、抽菸、膽固醇、糖尿病、肥胖、缺乏運動，是使用較普遍的心血管疾病風險評估因子。
　
有一些非傳統的風險評估因子，也可以用來計算心血管疾病的風險。常常在高級健康檢查的項目出現，包含：
　
冠狀動脈鈣化指數 (coronary artery calcium score，CAC score)

足踝上臂動脈血壓比 (ankle-brachial index，ABI)

高敏感度 C 反應蛋白 (high sensitivity C-reactive protein，hsCRP)。
　
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美國的 US Preventive Services Task Force 對於這三個非傳統的風險因子，系統性的回顧臨床試驗的證據。
　
CAC score、ABI、hsCRP 對於傳統的心血管疾病風險計算，可以小幅增加鑑別力 (discrimination) 和風險預測 (reclassification)，但對於臨床是否有意義還未知。
　
在傳統的風險評估之外，目前證據不足以評估加上 CAC score、ABI、或 hsCRP 來做心血管疾病的治療決策，能否降低心血管疾病的發生。
　
USPSTF 的結論，對於無症狀成人的心血管疾病風險計算，現有證據不足以評斷，加上這些非傳統因子是否能預防心血管事件。