初級預防是指尚未發生疾病. 但因具備疾病危險因子. 發生疾病機率會提高. 所以採取各種策略降低危險因子.
2022台灣血脂治療指引(英文版)下面中文使用google自動翻譯
初級預防的定義
由於這是初級預防指南，因此首先應描述具有臨床意義的動脈粥樣硬化性心血管疾病（ASCVD）的定義。已有研究表明，動脈粥狀硬化最早可追溯至2歲兒童時期。一系列病理學研究，從朝鮮戰爭和越南戰爭中陣亡士兵的屍檢，到最近的青少年動脈粥樣硬化病理生物學決定因素研究和博加盧薩心臟研究，均表明冠狀動脈脂肪紋在生命早期形成，並且一部分青少年體內存在晚期纖維斑塊。過去幾十年來的大量證據表明，吸菸、血脂異常、高血壓、胰島素抗性、肥胖和糖尿病等心血管危險因子會加速整個生命週期的動脈粥狀硬化進程。 「初級預防」的主要目的是透過消除或改變危險因子來預防具有臨床意義的動脈粥狀硬化性心血管疾病（ASCVD）。
具有臨床意義的ASCVD包括：
（1）冠狀動脈疾病（CAD），例如運動負荷試驗陽性的心絞痛和/或影像學檢查顯示主要冠狀動脈直徑狹窄>50%；
（2）急性冠脈綜合徵（ACS），例如心肌梗塞和不穩定型心絞痛；
（3）腦血管疾病，如短暫性腦缺血發作、缺血性中風和影像學檢查顯示頸動脈狹窄>50%；
（4）週邊動脈疾病（PAD），影像學檢查顯示主要肢體動脈直徑狹窄>50%；以及
（5）主動脈粥樣硬化性疾病，如影像學檢查顯示腹主動脈瘤。
對於臨床顯著的動脈粥狀硬化性心血管疾病（ASCVD）患者，血脂異常的治療應參考2017年台灣高風險族群血脂指引及其更新版的建議。本初級預防指引闡述了無臨床顯著ASCVD族群血脂控制的一般原則。
風險分層是決定一級預防降血脂策略的第一步。
建議：
臨床上顯著的ASCVD患者需要立即強化降低低密度脂蛋白膽固醇（LDL-C）水準。 （建議等級I，證據等級A）
臨床上顯著的ASCVD患者需要立即強化降低低密度脂蛋白膽固醇（LDL-C）水準。 （建議等級I，證據等級A）
對於無臨床顯著ASCVD族群的一級預防，需要進行風險分層以確定降血脂策略。 （建議等級I，證據等級B）
Definition of primary prevention Since this is a primary prevention guideline, the definitions of clinically significant ASCVD should be described first. It has been demonstrated that atherosclerosis originates in childhood as early as 2 years of age. A series of pathology studies, from autopsies of soldiers killed in the Korean and Vietnam Wars to the more recent Pathobiological Determinants of Atherosclerosis in Youth12 and Bogalusa Heart studies,13 demonstrated that coronary fatty streaks develop early in life and advanced fibrous plaques are present in a proportion of adolescents. During the past decades, convincing evidence has emerged that CV risk factors, such as cigarette smoking, dyslipidemia, hypertension, insulin resistance, obesity, and DM, accelerate the atherosclerotic process throughout the life span.14 The major purpose of “primary prevention” refers to prevention of clinically significant ASCVD by removing or modifying risk factors. The clinically significant ASCVD include: (1) CAD, such as angina with positive stress test and/or major coronary artery diameter stenosis >50% by imaging studies; (2) ACS, such as myocardial infarction and unstable angina; (3) cerebrovascular disease, such as transient ischemic attack, ischemic stroke, and carotid artery stenosis >50% by imaging studies; (4) PAD with major extremity artery diameter stenosis >50% by imaging studies; and (5) aortic atherosclerotic disease, such as abdominal aortic aneurysm by imaging studies. Treatment of dyslipidemia for clinically significant ASCVD should be referred to the recommendations in the 2017 Taiwan Lipid Guidelines for High Risk Patients and its focused update. This primary prevention guideline addresses the general principles of lipid control in subjects without clinically significant ASCVD. Risk stratification is the first step to determine the lipid lowering strategy in primary prevention.
Recommendation
Clinically significant ASCVD needs immediate and intensive reduction of LDL-C. (COR I, LOE A) For primary prevention in subjects without clinically significant ASCVD, risk stratification is necessary to determine the lipid lowering strategy. (COR I, LOE B)
Definition of primary prevention Since this is a primary prevention guideline, the definitions of clinically significant ASCVD should be described first. It has been demonstrated that atherosclerosis originates in childhood as early as 2 years of age. A series of pathology studies, from autopsies of soldiers killed in the Korean and Vietnam Wars to the more recent Pathobiological Determinants of Atherosclerosis in Youth12 and Bogalusa Heart studies,13 demonstrated that coronary fatty streaks develop early in life and advanced fibrous plaques are present in a proportion of adolescents. During the past decades, convincing evidence has emerged that CV risk factors, such as cigarette smoking, dyslipidemia, hypertension, insulin resistance, obesity, and DM, accelerate the atherosclerotic process throughout the life span.14 The major purpose of “primary prevention” refers to prevention of clinically significant ASCVD by removing or modifying risk factors. The clinically significant ASCVD include: (1) CAD, such as angina with positive stress test and/or major coronary artery diameter stenosis >50% by imaging studies; (2) ACS, such as myocardial infarction and unstable angina; (3) cerebrovascular disease, such as transient ischemic attack, ischemic stroke, and carotid artery stenosis >50% by imaging studies; (4) PAD with major extremity artery diameter stenosis >50% by imaging studies; and (5) aortic atherosclerotic disease, such as abdominal aortic aneurysm by imaging studies. Treatment of dyslipidemia for clinically significant ASCVD should be referred to the recommendations in the 2017 Taiwan Lipid Guidelines for High Risk Patients and its focused update. This primary prevention guideline addresses the general principles of lipid control in subjects without clinically significant ASCVD. Risk stratification is the first step to determine the lipid lowering strategy in primary prevention.
Recommendation
Clinically significant ASCVD needs immediate and intensive reduction of LDL-C. (COR I, LOE A) For primary prevention in subjects without clinically significant ASCVD, risk stratification is necessary to determine the lipid lowering strategy. (COR I, LOE B)
沒有留言:
張貼留言