2022台灣血脂治療指引(英文版)下面中文使用google自動翻譯
引言
心血管疾病（CVD），包括動脈粥狀硬化性心血管疾病（ASCVD），是台灣地區的主要死因之一。多項實驗室、流行病學和遺傳學研究證據表明，循環中低密度脂蛋白膽固醇（LDL-C）水平升高會導致膽固醇在動脈壁加速沉積，進而引發血管發炎和動脈粥狀硬化。許多臨床試驗進一步證實了LDL-C與ASCVD之間的因果關係，結果表明，強化降低LDL-C水平是減緩冠狀動脈粥樣硬化進展和改善心血管預後的有效療法。 近期研究表明，對於未確診冠狀動脈粥樣硬化的個體，早期開始使用他汀類藥物降低LDL-C水平，可以獲得與未接受治療的低LDL-C水平個體相似的心血管風險。 顯然，在生命早期維持適當的LDL-C水平是預防ASCVD的有效介入措施。然而，台灣的低密度脂蛋白膽固醇（LDL-C）控制率令人失望。即使在動脈粥狀硬化性心血管疾病（ASCVD）患者中，僅有54%的患者LDL-C水平能達到<100 mg/dL。 台灣血脂與動脈粥狀硬化學會聯合台灣其他七個主要學會於2017年發布了《台灣高危險群血脂指南》。 此指引針對高風險族群，包括冠狀動脈疾病（CAD）、急性冠狀動脈症候群（ACS）、缺血性中風、週邊動脈疾病（PAD）、糖尿病（DM）、慢性腎臟病（CKD）和家族性高膽固醇血症（FH）患者，建議了最佳血脂目標值和治療策略。 2017年版《台灣高危險群血脂指南》在台灣廣受好評，並成為高風險族群血脂異常治療的標準指南。但該指引並未提及不具備上述高風險特徵族群的血脂異常管理。 2005年至2008年台灣營養與健康調查顯示，高膽固醇血症（定義為膽固醇水平≥240 mg/dL）在男性中的盛行率為12.5%，在女性中為10%。 台灣血脂與動脈粥狀硬化學會決定推進一級預防，並制定了一項新的血脂指南，旨在針對無臨床顯著動脈粥樣硬化性心血管疾病（ASCVD）但可能存在其他各種血管危險因素的人群。台灣血脂與動脈粥狀硬化學會於2020年11月至2021年3月召開了諮詢委員會會議。來自台灣家庭醫學會、台灣心臟學會、台灣中風學會、台灣糖尿病學會、台灣糖尿病教育者協會、台灣腎臟病學會和台灣血脂教育者協會的專家和意見領袖出席了諮詢委員會會議並提出了重要建議。科學證據是該指引的主要依據。然而，我們認識到，台灣可能缺乏足夠的數據來支持血脂異常一級預防管理各個方面的建議。許多建議是專家討論後達成的共識。與2017年台灣高風險族群血脂診療指引類似，本指引採用建議等級（COR）和證據等級（LOE）來描述建議的強度及其相關的科學證據。 建議等級分為三級：I級（建議有用、有指徵且必要）、IIa級（建議可能有用且有指徵，但證據強度低於I級）、IIb級（建議可以考慮，但其效果尚不明確）和III級（建議涉及有害、禁忌且不應進行的治療）。
證據等級也分為三級：A級（建議有多項隨機臨床試驗支援）、B級（建議僅來自有限的隨機試驗或觀察性研究）和C級（建議來自專家共識）。
Introduction Cardiovascular (CV) disease, including atherosclerotic cardiovascular disease (ASCVD), is one of the major leading causes of death in Taiwan.1 Multiple evidences from laboratory, epidemiological, and genetic studies indicate that increased circulating low-density lipoprotein cholesterol (LDL-C) causes accelerated deposition of cholesterol in the arterial wall leading to vascular inflammation and atherosclerosis.2,3 The causal link of LDL-C and ASCVD was further proved in many clinical trials showing that intensive reduction of LDL-C is an effective therapy to attenuate the progression of coronary atherosclerosis and improve CV outcomes.4e7 Recent study demonstrated that, in individuals without established coronary atherosclerosis, early initiation of statin therapy to decrease LDL-C could obtain a similar CV risk as those with untreated low LDL-C levels.8 It is clear that maintaining an adequate LDL-C level earlier in life is an effective intervention for prevention of ASCVD. However, the control rate of LDL-C is disappointing in Taiwan. Even in patients with ASCVD, only 54% of them could achieve an LDL-C level <100 mg/dL.9 The Taiwan Society of Lipids and Atherosclerosis, in association with seven other major societies in Taiwan, published the Taiwan Lipid Guidelines for High Risk Patients in 2017.10 The optimal lipid target and treatment strategy were recommended for high risk patients, including those with coronary artery disease (CAD), acute coronary syndrome (ACS), ischemic stroke, peripheral artery disease (PAD), diabetes mellitus (DM), chronic kidney disease (CKD), and familial hypercholesterolemia (FH). The 2017 Taiwan Lipid Guidelines for High Risk Patients received critical acclaim in Taiwan and became the standard guidance for dyslipidemia treatment in high risk patients. The management of dyslipidemia for subjects without the above-mentioned high risk features was not mentioned in the 2017 guidelines. In the Nutrition and Health Surveys in Taiwan performed from 2005 to 2008, hypercholesterolemia defined as a cholesterol level 240 mg/dL was found in 12.5% in men and 10% in women.11 The Taiwan Society of Lipids and Atherosclerosis decided to move forward to primary prevention and developed a new lipid guideline targeting the subjects without clinically significant ASCVD, but may carry other various vascular risk factors. Advisory board meetings were held by the Taiwan Society of Lipids and Atherosclerosis from November 2020 to March 2021. Experts and opinion leaders from the Taiwan Association of Family Medicine, Taiwan Society of Cardiology, Taiwan Stroke Society, Taiwan Diabetes Association, Taiwan Association of Diabetes Educators, Taiwan Society of Nephrology and Taiwan Association of Lipid Educators attended the advisory board meetings and gave important suggestions. Scientific evidence is the major consideration of the guideline. However, we recognized that there may be insufficient data in Taiwan to support the recommendations in every aspect of dyslipidemia management for primary prevention. Many recommendations were consensus from the expert opinions after discussion. Similar to the 2017 Taiwan Lipid Guidelines for High Risk Patients, this guideline uses class of recommendation (COR) and level of evidence (LOE) to describe the intensities of the recommendations and their related scientific evidence.10 The COR includes 3 levels, including class I (the recommendations are useful, indicated, and necessary), class IIa (the recommendations maybe useful and indicated, but their intensity of evidence are less than class I), class IIb (the recommendations could be considered but their effects are less well established) and class III (the recommendations refer to the treatment that is harmful, contraindicated, and should not be done). The LOE also has 3 levels, including LOE A (the recommendations are supported by multiple randomized clinical trials), LOE B (the recommendations are from limited randomized trials or observational studies only), LOE C (the recommendations are from experts’ consensus).
Introduction Cardiovascular (CV) disease, including atherosclerotic cardiovascular disease (ASCVD), is one of the major leading causes of death in Taiwan.1 Multiple evidences from laboratory, epidemiological, and genetic studies indicate that increased circulating low-density lipoprotein cholesterol (LDL-C) causes accelerated deposition of cholesterol in the arterial wall leading to vascular inflammation and atherosclerosis.2,3 The causal link of LDL-C and ASCVD was further proved in many clinical trials showing that intensive reduction of LDL-C is an effective therapy to attenuate the progression of coronary atherosclerosis and improve CV outcomes.4e7 Recent study demonstrated that, in individuals without established coronary atherosclerosis, early initiation of statin therapy to decrease LDL-C could obtain a similar CV risk as those with untreated low LDL-C levels.8 It is clear that maintaining an adequate LDL-C level earlier in life is an effective intervention for prevention of ASCVD. However, the control rate of LDL-C is disappointing in Taiwan. Even in patients with ASCVD, only 54% of them could achieve an LDL-C level <100 mg/dL.9 The Taiwan Society of Lipids and Atherosclerosis, in association with seven other major societies in Taiwan, published the Taiwan Lipid Guidelines for High Risk Patients in 2017.10 The optimal lipid target and treatment strategy were recommended for high risk patients, including those with coronary artery disease (CAD), acute coronary syndrome (ACS), ischemic stroke, peripheral artery disease (PAD), diabetes mellitus (DM), chronic kidney disease (CKD), and familial hypercholesterolemia (FH). The 2017 Taiwan Lipid Guidelines for High Risk Patients received critical acclaim in Taiwan and became the standard guidance for dyslipidemia treatment in high risk patients. The management of dyslipidemia for subjects without the above-mentioned high risk features was not mentioned in the 2017 guidelines. In the Nutrition and Health Surveys in Taiwan performed from 2005 to 2008, hypercholesterolemia defined as a cholesterol level 240 mg/dL was found in 12.5% in men and 10% in women.11 The Taiwan Society of Lipids and Atherosclerosis decided to move forward to primary prevention and developed a new lipid guideline targeting the subjects without clinically significant ASCVD, but may carry other various vascular risk factors. Advisory board meetings were held by the Taiwan Society of Lipids and Atherosclerosis from November 2020 to March 2021. Experts and opinion leaders from the Taiwan Association of Family Medicine, Taiwan Society of Cardiology, Taiwan Stroke Society, Taiwan Diabetes Association, Taiwan Association of Diabetes Educators, Taiwan Society of Nephrology and Taiwan Association of Lipid Educators attended the advisory board meetings and gave important suggestions. Scientific evidence is the major consideration of the guideline. However, we recognized that there may be insufficient data in Taiwan to support the recommendations in every aspect of dyslipidemia management for primary prevention. Many recommendations were consensus from the expert opinions after discussion. Similar to the 2017 Taiwan Lipid Guidelines for High Risk Patients, this guideline uses class of recommendation (COR) and level of evidence (LOE) to describe the intensities of the recommendations and their related scientific evidence.10 The COR includes 3 levels, including class I (the recommendations are useful, indicated, and necessary), class IIa (the recommendations maybe useful and indicated, but their intensity of evidence are less than class I), class IIb (the recommendations could be considered but their effects are less well established) and class III (the recommendations refer to the treatment that is harmful, contraindicated, and should not be done). The LOE also has 3 levels, including LOE A (the recommendations are supported by multiple randomized clinical trials), LOE B (the recommendations are from limited randomized trials or observational studies only), LOE C (the recommendations are from experts’ consensus).
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