最新欧洲血脂异常管理指南更新要点PPT文档.pptx
2016年8月ESC于意大利首都罗马召开2016年年会期间发布了备受瞩目的2016欧洲心脏病学会/欧洲动脉粥样硬化学会血脂异常管理指南,坚持总体的心血管风险评估扩大风险评估及极高危人群范畴,PART ONE,核心策略,SCORE评分,2016 年指南继续强调评价患者整体心血管风险、强调生活方式改良是管理血脂异常的核心策略,对于年龄40岁的无心血管病、糖尿病、慢性肾病或家族性高胆固醇血症证据的无症状成年人，建议应用SCORE评分等风险评估系统评估总体心血管风险,SCORE 评分,1.Based on large,representativeEuropean cohort datasets.2.SCORE is intended to facilitate risk estimation apparently healthy persons with no documented CVD.3.Persons with documented CVD、type 1 or type 2 diabetes、very high levels of individual risk factors、chronic kidney disease（CKD）are automatically at very high or high total CV risk.No risk estimation models are needed for themthey all need active management of all risk factors.,SCORE 评分,4.The SCORE system estimates the 10-year cumulative risk of a first fatal atherosclerotic event,whether heart attack,stroke or other occlusive arterial disease,including sudden cardiac death.5.The SCORE data indicate that the total CVD event risk is about three times higher than the risk of fatal CVD for men,so that a SCORE risk of 5%translates into a CVD risk of 15%of total(fatal+non-fatal)hard CVD endpointsthe multiplier is 4 in women and lower in older persons.,How to use the risk estimation charts,Low risk are based on age-adjusted 2012 CVD mortality rates(225/100 000 in men and,175/100 000 in women)the low-risk charts should be considered for use in Austria,Belgium,Cyprus,Czech Republic,Denmark,Finland,France,Germany,Greece,Iceland,Ireland,Israel,Italy,Luxembourg,Malta,The Netherlands,Norway,Portugal,San Marino,Slovenia,Spain,Sweden,Switzerland and the United Kingdom.,How to use the risk estimation charts,3.450/100 000 for men or 350/100 000 for women 4.Albania,Algeria,Armenia,Azerbaijan,Belarus,Bulgaria,Egypt,Georgia,Kazakhstan,Kyrgyzstan,Latvia,FYR Macedonia,Republic of Moldova,RussianFederation,Syrian Arab Republic,Tajikistan,Turkmenistan,Ukraine,Uzbekistan,Bosnia Herzegovina,Croatia,Estonia,Hungary,Lithuania,Montenegro,Morocco,Poland,Romania,Serbia,Slovakia,Tunisia and Turkey.,To Young People,1.Young people with high levels of risk factors;a low absolute risk may conceal a very high relative risk requiring intensive lifestyle advice.2.To motivate young people not todelay changing their unhealthy lifestyle,an estimate of their relative risk,illustrating that lifestyle changes can reduce relative risk substantially may be helpful3.The risk age of a person with several CV risk factors is the age of a person with the same level of risk but with ideal levels of risk factors,Risk age is an intuitive and easily understood way of illustratingthe likely reduction in life expectancy that a young person witha low absolute but high relative risk of CVD will be exposed to if preventive measures are not adopted.,the risk age is calculated compared with someone with ideal risk factor levels,which have been taken as non-smoking,total cholesterol of 4 mmol/L(155 mg/dL)and systolic blood pressure of 120 mmHg.,危险分层,低中危,高危,极高危,1.2016 年指南保留了2011 年指南的极高危、高危、中危和低危四个危险分层,2.在2011 年指南对极高危患者界定的基础上，2016 年指南将高危人群范畴进一步扩大,3.2016 年指南中，极高危人群进一步扩大，将冠状动脉造影或颈动脉超声检查发现斑块的患者、短暂性脑缺血发作的患者也纳入了极高危人群的范畴。,坚持低密度脂蛋白胆固醇(LDL-C)是核心靶目标，强调越低越好的管理理念,ADD YOUR TITLE HERE,$,指南强调 LDL-C达标是血脂管理的核心靶目标，并保留了LDL-C 目标值，建议LDL-C 作为首选治疗靶目标。,与2011 年指南及2013 年美国心脏病学院/美国心脏协会血胆固醇治疗指南相比，2016 年指南强调要进一步严格控制胆固醇水平，建议控制的靶目标甚至比美国指南更严格。,调控目标,1,2,3,中低危人群的LDL-C控制目标为3.0mmol/L,极高危及高危人群的LDL-C控制目标分为1.8 mmol/和2.6mmol/L,若患者血脂水平不是特别高，如极高危患者的LDL-C 为1.8 3.5mmol/L，指南要求至少应将其LDL-C水平降低50%。这就意味着若患者基线LDL-C水平为3.0mmol/L，需要将LDL-C水平至少降至1.5mmol/L。同时对于基线胆固醇水平较低患者，建议将LDL-C降低50%作为治疗目标，以指导LDL-C接近目标值时的降脂治疗策略。,血脂检测,2016 年指南简化了血脂检测手段,建议测量血脂时不一定非要空腹，空腹及非空腹测量均可。,但是三酰甘油(TG)易受饮食影响，建议高甘油三酯血症患者评估应空腹测量,坚持他汀一线基石地位强调长期治疗的必要性,他汀仍是唯一一线用药,其他降脂类药物仅仅是对他汀治疗的一个补充。,他汀作为唯一一线用药的建议并未改变所有血脂异常患者尤其是高胆固醇血症患者都应首选他汀类药物进行降脂治疗,与2011 年指南相比，2016 年指南对于调脂药物的建议并无明显改变，但有一些细微差异。,依折麦布是唯一二线用药,2016 年指南所建议的二线药物与既往指南相比有了一定的变化,对胆固醇吸收抑制剂依折麦布，2016 年指南建议其可作为二线药物用于治疗他汀不能耐受的患者或他汀足剂量治疗后未达标的患者。,2016 年指南肯定了PCSK9 抑制药的降脂效果，但因缺乏大规模随机临床试验，目前建议其用于治疗难治性及未耐受他汀治疗的患者，以及家族性高胆固醇血症患者（三线用药）,鉴于近年来研究显示，在他汀基础上加用烟酸类药物不能为患者带来获益，欧洲也已经不允许烟酸类药物上市，故2016 年指南在二线药物建议中去掉了烟酸类药物,虽然患者的危险分层不同，血脂控制的靶目标可能有所不同，但都应首先进行他汀治疗，并尽可能用到最大建议剂量或最大耐受剂量。只有在上述前提下，才可以考虑是否需要追加第二种或第三种药物。,坚持ACS患者强化他汀治疗强调他汀早期、长期坚持治疗,ACS患者的调脂治疗,2016 年指南指出，ACS 患者首先应全面控制心血管病危险因素,无论患者的基线LDL-C 水平如何，都需早期、在住院后1 4 d 内常规启动高强度他汀治疗，目标是使LDL-C 降到 1.8 mmol/L或使LDL-C 至少降低50%(基线LDL-C 为1.8 3.5 mmol/L)。,仅在高强度他汀治疗增加不良反应风险的人群(如老年人、肝功能损伤、肾功能损伤或可能与必须的合并治疗产生相互作用的患者)，才考虑更低强度的他汀治疗。仍然强调在他汀治疗干预4 6 周后要检测血脂水平并调整治疗策略(血脂达标及安全性)。,ESC血脂异常管理指南建议的LDL-C治疗目标值,Add your text here and write down your personal idea add your text here and write down your personal idea add your text here and write down your personal idea,几个问题,SOME QUESTION,THANKS,
