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为了回答上述问题,我国四川大学华西医院郝秋奎副教授、李舍予副教授团队于2022年5月在英国医学杂志(BMJ)牵头发布了《非他汀类降脂药物PCSK9抑制剂及依折麦布的国际临床应用指南2022》(以下称“新指南”)。 对此将从以下四个方面进行解读。 该指南在汇集了最新临床试验数据的基础上,对非他汀类药物的使用、动脉粥样硬化性心血管疾病(ASCVD)的风险评估以及血脂管理的目标等核心内容进行了全面的更新。 推荐在生活方式干预的基础上,以中等强度他汀类药物作为起始药物治疗,必要时联用胆固醇吸收抑制剂和/或前蛋白转化酶枯草溶菌素9 抑制剂的达标策略。 新指南涵盖了从儿童到老年全生命周期的血脂管理。 他汀类药物对ASCVD的总体益处远大于新增糖尿病风险,无论是糖尿病高危人群还是糖尿病患者,有他汀类药物治疗适应证者都应坚持服用此类药物。
对于患有心血管疾病或ASCVD风险增加的成人高甘油三酯血症(1.7~5.6 mmol/L)患者,建议在他汀类药物基础上使用EPA(IPE)。 更有效地将LDL⁃C水平减半[15] 。 由于这两种药物具有良好的协同作用,因此出现了一款同时含有这两种药物的合剂,名为依折麦布阿托伐他汀钙片,因有效的降脂作用以及减少患者服药的种类,面世之后就受到患者和医生的青睐。在最新的调脂方案专家共识中已经. 对此,8月25日,美国心脏病学会(ACC)发布了《ACC专家共识:ASCVD风险管理中降LDL-C的非他汀类药物治疗决策路径2022》,对上述问题作了清晰的回答。 一般来说,他汀类药物有较好的安全性和耐受性,但及时识别和处理相关不良反应也非常重要。 他汀类药物的不良反应与使用剂量有关,常见的不良反应包括肝功能异常、肌损害等。
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