2022 focused update of the 2017 Taiwanlipid guidelines for high risk patients:Coronary artery disease, peripheral arterydisease and ischemic stroke
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引言
2017年，台灣血脂與動脈粥狀硬化學會聯合台灣心臟學會、台灣心血管介入學會、台灣中風學會、台灣糖尿病學會、台灣糖尿病教育者協會及台灣腎臟病學會，發布了《2017年台灣高風險病患血脂指南》<sup>1</sup>。本指引建議了冠狀動脈疾病（CAD）、急性冠狀動脈症候群（ACS）、週邊動脈疾病（PAD）、缺血性中風、糖尿病、慢性腎臟病及家族性高膽固醇血症患者的最佳血脂目標值及治療策略<sup>1</sup>。 2017年指引發布後，關於動脈粥狀硬化性心血管疾病（ASCVD）患者降血脂治療的新科學證據相繼發表。尤其值得一提的是，近期發表了關於前蛋白轉化酶枯草桿菌蛋白酶/kexin 9型（PCSK9）抑製劑治療急性冠脈綜合徵/冠狀動脈疾病（ACS/CAD）以及他汀類藥物強化降脂治療動脈粥樣硬化性缺血性卒中或短暫性腦缺血發作（TIA）患者的重要臨床試驗。 <sup>2e4</sup> 研究結果改變了這些高風險病患的治療理念。因此，有必要更新針對這些患者的降血脂治療策略。本次更新的重點在於，其建議基於近期發表的臨床試驗的科學證據，並結合專家意見和台灣地區實際情況進行了調整。本指南更新草稿由台灣血脂與動脈粥狀硬化學會起草，並送交台灣心臟學會、台灣心血管介入學會及台灣中風學會審查。最終版本經上述學會認可。與往常一樣，本次指南更新採用了與 2017 年指南相同的實證分類系統，包括 3 個建議等級 (COR) 和 3 個證據等級 (LOE)。
Introduction In 2017, the Taiwan Society of Lipids and Atherosclerosis, in association with the Taiwan Society of Cardiology, Taiwan Society of Cardiovascular Intervention, Taiwan Stroke Society, Taiwan Diabetes Association, Taiwanese Association of Diabetes Educators and Taiwan Society of Nephrology, published the 2017 Taiwan Lipid Guidelines for High Risk Patients.1 The optimal lipid target and treatment strategy were recommended for patients with coronary artery disease (CAD), acute coronary syndrome (ACS), peripheral artery disease (PAD), ischemic stroke, diabetes mellitus, chronic kidney disease, and familial hypercholesterolemia.1 After publication of the 2017 guideline, new scientific evidence regarding lipid lowering therapy in patients with atherosclerotic cardiovascular disease (ASCVD) was reported successively. In particular, there were important clinical trials published about proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors for ACS/CAD and intensive lipid lowering with statins among patients with ischemic stroke or transient ischemic attack (TIA) of atherosclerotic origin.2e4 The study results changed the treatment concept in these high risk patients. Therefore, an update focusing on the lipid treatment strategy for these patients becomes necessary. The recommendations in this focused update were made based on the scientific evidence from recently published clinical trials but modified by the expert opinions and considerations of the real-world situation in Taiwan. The draft of this guideline update was developed by the Taiwan Society of Lipids and Atherosclerosis and sent to the Taiwan Society of Cardiology, Taiwan Society of Cardiovascular Intervention and Taiwan Stroke Society for review. The final document was endorsed by these societies. As usual, the guideline update adopted the same evidence-based classification system as the 2017 guideline, including 3 classes of recommendation (COR) and 3 levels of evidence (LOE)
Introduction In 2017, the Taiwan Society of Lipids and Atherosclerosis, in association with the Taiwan Society of Cardiology, Taiwan Society of Cardiovascular Intervention, Taiwan Stroke Society, Taiwan Diabetes Association, Taiwanese Association of Diabetes Educators and Taiwan Society of Nephrology, published the 2017 Taiwan Lipid Guidelines for High Risk Patients.1 The optimal lipid target and treatment strategy were recommended for patients with coronary artery disease (CAD), acute coronary syndrome (ACS), peripheral artery disease (PAD), ischemic stroke, diabetes mellitus, chronic kidney disease, and familial hypercholesterolemia.1 After publication of the 2017 guideline, new scientific evidence regarding lipid lowering therapy in patients with atherosclerotic cardiovascular disease (ASCVD) was reported successively. In particular, there were important clinical trials published about proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors for ACS/CAD and intensive lipid lowering with statins among patients with ischemic stroke or transient ischemic attack (TIA) of atherosclerotic origin.2e4 The study results changed the treatment concept in these high risk patients. Therefore, an update focusing on the lipid treatment strategy for these patients becomes necessary. The recommendations in this focused update were made based on the scientific evidence from recently published clinical trials but modified by the expert opinions and considerations of the real-world situation in Taiwan. The draft of this guideline update was developed by the Taiwan Society of Lipids and Atherosclerosis and sent to the Taiwan Society of Cardiology, Taiwan Society of Cardiovascular Intervention and Taiwan Stroke Society for review. The final document was endorsed by these societies. As usual, the guideline update adopted the same evidence-based classification system as the 2017 guideline, including 3 classes of recommendation (COR) and 3 levels of evidence (LOE)
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