Clinical Practice 2022 Taiwan lipid guidelines for primary prevention 05

台灣2022年血脂治療指引部分更新

沒有高風險的受試者 在沒有 DM、CKD 和 LDL-C 190 mg/dL 的受試者中，應評估 ASCVD 的其他危險因素。這些包括：(1) 高血壓，(2) 男性年齡大於 45 歲或女性大於 55 歲或絕經期女性，(3) 早發 CAD 家族史（男性小於 55 歲或女性小於 65 歲）女性），(4) 高密度脂蛋白膽固醇 (HDL-C) 男性低於 40 mg/dL 或女性低於 50 mg/dL 和 (5) 吸煙。 35 因為向心性肥胖、糖尿病前期和甘油三酯 (TG)在一些研究中也被認為是 ASCVD 危險因素，包括所有這些項目的代謝綜合徵在本指南中被視為第六個獨立危險因素。代謝綜合徵是根據修改後的亞洲人國家膽固醇教育計劃成人治療小組 III 定義的。 36，37 滿足以下三個或更多標準的患者被認為患有代謝綜合徵：(1) 男性腰圍大於 90 厘米或女性大於 80 厘米，(2) 血壓為 130/ 85 毫米汞柱或更高或使用抗高血壓藥物，(3) 空腹血糖水平為 100 mg/dL 或更高或使用抗糖尿病藥物，(4) 空腹 TG 水平為 150 mg/dL 或更高或使用降脂劑以增加 TG，以及 ( 5) HDL-C 男性低於 40 mg/dL 或女性低於 50 mg/dL（表 1）。基於上述風險因素評估，一級預防對象可分為以下風險類別。高風險表示受試者患有 DM、CKD 或 LDL-C 190 mg/dL。在那些沒有 DM、CKD 或 LDL-C 190 mg/dL 的人中，中度風險表示受試者有 2 個或更多風險因素，低風險表示有 1 個風險因素，最小風險表示沒有風險因素。高風險受試者需要立即降脂治療以達到推薦的LDL-C目標。對於沒有高風險的受試者，建議首先改變生活方式 3 個月，然後再考慮降脂治療。表 2 總結了初級預防的總體風險類別。

建議
對於一級預防，患有 DM、非透析性 CKD 或 LDL-C 190 mg/dL 的受試者處於 ASCVD 的高風險中，需要立即進行降脂治療。（COR I，LOE A）在沒有 DM、CKD 或 LDL-C 190 mg/dL 的受試者中，ASCVD 的風險應根據風險因素分類為最小、低或中等。（COR I，LOE C）

Subjects without high risk In subjects without DM, CKD, and LDL-C
190 mg/dL, other risk factors of ASCVD should be evaluated. These include: (1) hypertension, (2) age greater than 45 years in men or greater than 55 years in women or menopausal women, (3) family history of premature CAD (less than 55 years in men or less than 65 years in women), (4) high-density lipoprotein cholesterol (HDL-C) less than 40 mg/dL in men or less than 50 mg/dL in women and (5) smoking.35 Because central obesity, prediabetes and triglyceride (TG) are also considered to be ASCVD risk factors in some studies, metabolic syndrome that include all these items is regarded as the sixth independent risk factor in this guideline. Metabolic syndrome is defined according to the modified National Cholesterol Education Program Adult Treatment Panel III for Asians.36,37 Patients who meet three or more of the following criteria are considered to have metabolic syndrome: (1) waist circumference greater than 90 cm in men or greater than 80 cm in women, (2) blood pressure of 130/ 85 mmHg or higher or use of antihypertensive medication, (3) fasting glucose level of 100 mg/dL or higher or use of antidiabetic drug, (4) fasting TG level of 150 mg/dL or higher or use of lipid-lowering agent for increased TG, and (5) HDL-C less than 40 mg/dL in men or less than 50 mg/dL in women (Table 1). Based on the above-mentioned risk factor evaluation, the subjects with primary prevention can be classified into the following risk categories. High risk indicates subjects with DM, CKD or LDL-C
190 mg/dL. In those without DM, CKD or LDL-C
190 mg/dL, moderate risk indicates subjects with 2 or more risk factors, low risk indicates with 1 risk factor and minimal risk indicates no risk factor. Subjects with high risk need immediate lipid lowering therapy to reach the recommended LDL-C target. Lifestyle modification first is recommended for 3 months before considering lipid lowering therapy in the subjects without high risk. The overall risk categories for primary prevention are summarized in Table 2.

Recommendation
For primary prevention, subjects with DM, nondialysis CKD, or LDL-C
190 mg/dL are at high risk of ASCVD and immediate lipid lowering therapy is necessary. (COR I, LOE A) In subjects without DM, CKD, or LDL-C
190 mg/dL, the risk of ASCVD should be classified as minimal, low, or moderate according to the risk factors. (COR I, LOE C)