2022台灣血脂治療指引(英文版)下面中文使用google自動翻譯
依澤替米貝用於一級預防
依折麥布是一種膽固醇吸收抑制劑，它能阻斷腸道刷狀緣對飲食和膽汁膽固醇的吸收。在慢性腎臟病（CKD）或急性冠狀動脈綜合症（ACS）患者中，依折麥布合併他汀類藥物預防動脈粥狀硬化性心血管疾病（ASCVD）的療效已在大規模研究中得到充分證實。 <sup>107,108</sup> EWTOPIA 75 試驗旨在研究依折麥布單藥治療在原發性預防的療效。 <sup>109</sup> 這項在日本進行的多中心、前瞻性、隨機臨床試驗，考察了依折麥布對年齡在 75 歲左右、低密度脂蛋白膽固醇（LDL-C）≥ 140 mg/dL 但無冠心病史患者的預防效果。在這項嚴謹的研究中，經過 4.1 年的中位追蹤期，依折麥布顯著降低了主要複合終點事件（包括猝死、心肌梗塞、冠狀動脈血運重建或中風）的發生率。這項研究證明了依折麥佈單藥治療對預防 75 歲及以上 LDL-C 水平升高的個體發生心血管事件的益處，可用於一級預防。
建議：對於單用他汀類藥物無法達到低密度脂蛋白膽固醇（LDL-C）目標值的初級預防患者，依折麥布可與他汀類藥物合併使用。 （證據等級 IIb，證據等級 B）。對於無法耐受他汀類藥物的初級預防患者，依折麥布可作為單一藥物治療。 （證據等級 IIb，證據等級 B）。
Ezetimibe for primary prevention
Ezetimibe is a cholesterol absorption inhibitor that blocks dietary and biliary cholesterol absorption at the brush border of the intestine. The efficacy of ezetimibe in combination with statin for prevention of ASCVD has been well demonstrated in patients with CKD or ACS in large-scale studies.107,108 The EWTOPIA 75 trial is a study to investigate the efficacy of ezetimibe monotherapy in primary prevention.109 This multicenter, prospective, randomized clinical trial was conducted in Japan and examined the preventive efficacy of ezetimibe for patients aged 75 years with LDLC 140 mg/dL but without history of CAD. In this elegant study, ezetimibe significantly reduced the incidence of the primary composite outcome, including sudden cardiac death, MI, coronary revascularization, or stroke, after a median follow-up of 4.1 years. This study proved the benefit of ezetimibe monotherapy in preventing CV events in individuals aged 75 years with elevated LDL-C for primary prevention.
Recommendation Ezetimibe may be used in combination with statin in patients with primary prevention who could not reach the LDL-C target with statin alone. (COR IIb, LOE B). Ezetimibe may be used as monotherapy in patients with primary prevention who cannot tolerate statins. (COR IIb, LOE B).
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