下面中文使用google自動翻譯
無高風險受試者
對於無糖尿病、慢性腎臟病且低密度脂蛋白膽固醇（LDL-C）低於190 mg/dL的受試者，應評估其他動脈粥狀硬化性心血管疾病（ASCVD）危險因子。這些因素包括：
建議
對於初級預防，患有糖尿病、非透析慢性腎臟病或低密度脂蛋白膽固醇（LDL-C）≥190 mg/dL 的個體發生動脈粥狀硬化性心血管疾病（ASCVD）的風險較高，需要立即進行降血脂治療。 （證據等級 I，證據等級 A）
無高風險受試者
對於無糖尿病、慢性腎臟病且低密度脂蛋白膽固醇（LDL-C）低於190 mg/dL的受試者，應評估其他動脈粥狀硬化性心血管疾病（ASCVD）危險因子。這些因素包括：
（1）高血壓；
（2）男性年齡大於45歲或女性年齡大於55歲或已停經；
（3）早期冠心病（CAD）家族史（男性小於55歲或女性小於65歲）；
（4）男性高密度脂蛋白膽固醇（HDL-C）低於40 mg/dL或女性低於50 mg/dL；5）
（5）吸菸。
由於一些研究也認為中心性肥胖、糖尿病前期和三酸甘油酯（TG）是ASCVD的危險因素，因此本指南將包含所有這些因素的代謝症候群視為第六個獨立危險因子。
代謝症候群的定義參照美國國家膽固醇教育計畫成人治療組第三次報告（NCEP ATP III）中針對亞洲人群的修訂版。
符合以下五項標準中三項或三項以上者，即可診斷為代謝症候群：
(1) 男性腰圍大於90 cm，女性腰圍大於80 cm；
(2) 血壓≥130/85 mmHg或正在服用降血壓藥物；
(3) 空腹血糖≥100 mg/dL或正在服用降血糖藥物
(4) 空腹甘油三酯（1095 mg）；男性高密度脂蛋白膽固醇（HDL-C）<40 mg/dL，女性HDL-C<50 mg/dL
基於上述危險因子評估，初級預防對象可分為下列風險類別。
高風險族群指患有糖尿病 (DM)、慢性腎臟病 (CKD) 或低密度脂蛋白膽固醇 (LDL-C) ≥ 190 mg/dL 的受試者。
對於未患有 DM、CKD 或 LDL-C ≥ 190 mg/dL 的族群，中度風險指具有 2 項或以上風險因子的受試者，低風險指有 1 項風險因子的受試者，極低風險指無風險因子的受試者。
高風險族群需要立即接受降血脂治療以達到建議的 LDL-C 目標值。對於非高風險族群，建議先進行 3 個月的生活方式乾預，然後再考慮降血脂治療。初級預防的總體風險類別總結於表 2。
建議
對於初級預防，患有糖尿病、非透析慢性腎臟病或低密度脂蛋白膽固醇（LDL-C）≥190 mg/dL 的個體發生動脈粥狀硬化性心血管疾病（ASCVD）的風險較高，需要立即進行降血脂治療。 （證據等級 I，證據等級 A）
對於未患糖尿病、慢性腎臟病或 LDL-C≥190 mg/dL 的個體，應根據危險因子將 ASCVD 風險分為極低、低或中等。 （證據等級 I，證據等級 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)
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)
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