2022-台灣高血脂初級預防指引- 8. LDL目標值-低度風險民眾

2025-12-09 11:08AM

2022台灣血脂治療指引(英文版)下面中文使用google自動翻譯

低危險群至微危險因子（<2個危險因子）：無危險因子或僅有一個危險因子的個體被歸類為低危險群至微危險群。對於低危險群至微危險群但LDL-C水準升高的患者，最佳管理方案仍有爭議。國際指引通常使用風險計算器進行10年風險評估，但往往忽略低風險的年輕患者，因為在未來十年內不太可能出現與動脈粥狀硬化性心血管疾病（ASCVD）相關的不良事件，然而，LDL-C水平升高仍然與日後ASCVD風險增加相關。 ⁴¹ 多項證據表明，ASCVD風險與終生LDL-C累積暴露量密切相關。 ^42,43 因此，有必要在生命早期採取措施控制LDL-C水平，以預防日後ASCVD的發生。新出現的證據表明，即使在初級預防中風險較低的人群中，降血脂治療的益處也可能非常顯著，尤其是在基線低密度脂蛋白膽固醇（LDL-C）水平為 135 mg/dL 時。 ⁴⁴ 對於沒有任何危險因子的族群，本指引建議，根據專家共識，LDL-C 水準的起始治療目標值為 160 mg/dL。對於僅有 1 個危險因子的族群，LDL-C 水準的起始治療目標值為 130 mg/dL。毫無疑問，對於這類人群，應優先考慮並強調非藥物治療和生活方式介入。在日本指引中，中度風險族群的低密度脂蛋白膽固醇（LDL-C）目標值為<140 mg/dL，低風險族群的目標值為<160 mg/dL。 ³⁹ 在韓國指引中，對於僅有一項或更少主要危險因子的族群，LDL-C目標值為<160 mg/dL。 ⁴⁰ 若在生活型態調整3個月後，LDL-C仍高於目標值，則先考慮使用中等強度的他汀類藥物。對於這類族群，可考慮進行進一步檢查，例如冠狀動脈鈣化評分，以重新評估動脈粥狀硬化性心血管疾病（ASCVD）風險並調整他汀類藥物的治療強度。對於低風險或微風險族群，是否需要進一步檢查或長期他汀類藥物治療，應在充分解釋和理解檢查及治療的益處和風險後，與患者共同做出決策。圖 1 總結了 LDL-C 一級預防的整體治療流程。

建議：對於具有 1 項危險因子且 LDL-C ≥ 130 mg/dL 的受試者，應開始非藥物治療，LDL-C 目標值為 < 130 mg/dL。 （COR IIa，LOE C）
對於無危險因子且低密度脂蛋白膽固醇 (LDL-C) ≥ 160 mg/dL 的受試者，應開始非藥物治療，LDL-C 目標值為 < 160 mg/dL。 （證據等級 IIa，C 級）對於有 0 至 1 項危險因子的受試者，如果經過 3 個月的非藥物治療後 LDL-C 仍未達到目標值，則在共同決策後可考慮使用中等強度他汀類藥物。 （證據等級 IIa，C 級）

Minimal to low risk (<2 risk factors) Individuals with no or only one risk factor are classified as the minimal to low risk category. The optimal way to manage subjects at minimal to low risk but with elevated LDL-C is still controversial. International guidelines using risk calculator for 10-year risk estimation are prone to ignore younger patients with low risk because it is unlikely to see ASCVD-related adverse outcomes in the forthcoming decade, but increased LDL-C is still associated with an increased risk of ASCVD later in life.41 Multiple evidences have proved that the risk of ASCVD is strongly correlated with the cumulative exposure to LDL-C in one’s lifetime.42,43 Therefore, it is necessary to act early in life to control LDL-C and prevent ASCVD later in life. Emerging evidence indicates that even among individuals with low risk at primary prevention, the benefit of lipid lowering therapy can be significant, especially when the baseline LDL-C is
135 mg/dL.44 For subjects without any risk factor, this guideline suggests that the LDL-C level for initiation of therapy and treatment target is 160 mg/dL based on the experts’ consensus. For subjects with only 1 risk factor, the LDL-C level for initiation of therapy and treatment target is 130 mg/dL. There is no doubt that nonpharmacologic therapy with lifestyle modification is preferred and should be emphasized in this group. In the Japanese guidelines, the LDL-C target is <140 mg/dL in moderate risk and <160 mg/dL in low risk category.39 In Korean guidelines, the LDL-C target is <160 mg/dL in those with one or fewer major risk factors.40 Moderate-intensity statins are considered first if LDL-C remains higher than the target after 3 months of lifestyle adjustment. Further examinations, such as coronary calcium score, could be considered in redefining ASCVD risk and changing the intensity of statin treatment in this category. The decision of further examinations or long-term statin therapy in subjects at minimal to low risk category should be made after shared decision making with explanation and understanding of the benefit and risk of the examinations and treatment. The overall treatment algorithm of LDL-C for primary prevention is summarized in Fig. 1.

Recommendation In subjects with 1 risk factor and LDL-C
130 mg/dL, non-pharmacological therapy should be initiated and the LDL-C target is <130 mg/dL. (COR IIa, LOE C)
In subjects without risk factor and LDL-C
160 mg/ dL, non-pharmacological therapy should be initiated and the LDL-C target is <160 mg/dL. (COR IIa, LOE C) In subjects with 0 to 1 risk factor, if the LDL-C target is not achieved after 3 months of nonpharmacological therapy, moderate-intensity statins could be considered after shared decision making. (COR IIa, LOE C)