2022-台灣高血脂初級預防指引- 13. 非藥物治療-戒菸

2025-12-09 11:08AM2022台灣血脂治療指引(英文版)下面中文使用googl e自動翻譯

吸菸是一種致命的成癮性疾病，每年有超過800萬人死於吸菸。 ⁹⁰ 在台灣，成年吸菸率已從2008年的21.9%（男性38.6%，女性4.8%）下降至2019年的13.1%（男性23.1%，女性2.9%）。 ⁹¹ 然而，吸菸仍在台灣造成大量生命損失，每年約有24,000人死於吸菸。 ⁹¹ 戒菸可以挽救生命，減輕醫療負擔，即使是60歲以上的老年吸菸者也能從中受益。 ⁹² 持續的醫學教育，包括對醫生和諮商師進行團體培訓，提升他們幫助人們戒菸的知識和技能，以及在各醫院之間開展戒菸服務競賽，已被證明能有效促進台灣高心血管風險吸菸者的戒菸。 ⁹³ 近年來，電子煙已成為一種流行的戒菸方式。然而，關於電子煙是否優於非電子菸戒菸方法的大規模統合分析結果卻相互矛盾。 ^94,95 此外，越來越多的證據引發了人們對電子煙使用不良反應的嚴重擔憂，例如電子煙或電子煙產品相關性肺損傷（EVALI）以及與電子煙使用相關的血壓升高和動脈僵硬。 ^96-98 總之，目前尚無確切證據顯示電子煙是更安全的戒菸替代方案，也沒有足夠的證據證明其長期心血管安全性。


建議：建議戒菸以降低整體心血管風險。 （證據等級 I，證據等級 A）
Cigarette smoking Smoking is a lethal addictive disorder and more than 8 million people die from smoking every year.90 In Taiwan, the prevalence of smoking among adult people has been declining from 21.9% (male 38.6%, female, 4.8%) in 2008 down to 13.1% (male 23.1%, female 2.9%) in 2019.91However, smoking still caused a huge loss of life in Taiwan and about 24,000 people die from smoking every year.91 Smoking cessation saves life and reduces healthcare burden and the benefits are seen even in old smokers (
60 years).92 Continued medical education with group training of doctors and counsellors regarding knowledge and skill to help people quitting smoking followed by smoking cessation service contest among hospitals has been proved effective to promote smoking cessation for high CV risk smokers in Taiwan.93 Electronic cigarettes (EC) have been emerging as a popular way to facilitate tobacco cessation in recent years. However, large-scale meta-analysis about whether EC is superior to non-EC methods for tobacco cessation showed conflicting results.94,95 In addition, growing evidence has raised critical concerns regarding the adverse effects of EC use, such as EC or vaping product-associated lung injury (EVALI) and increased blood pressure and arterial stiffness associated with EC use.96e98 Collectively, there is still no solid evidence supporting that EC is a safer alternative for tobacco cessation, neither is there sufficient evidence to claim its long-term CV safety.


Recommendation Cessation of cigarette smoking is recommended to reduce overall CV risk. (COR I, LOE A)

2022-台灣高血脂初級預防指引- 12. 非藥物治療-酒精攝取建議

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

酒精

酒精攝取與高密度脂蛋白膽固醇（HDL-C）水平升高有關，但酒精攝取與動脈粥狀硬化性心血管疾病（ASCVD）之間的關係尚存爭議。 ^73,74 雖然一些研究表明，少量飲酒與心血管風險和糖尿病風險降低有關，^75-77 但許多其他研究對這一觀點提出了質疑。 ^78-81 近期，一項對來自19個高收入國家（新興風險因素協作組、EPIC-CVD和英國生物銀行）的3個大型數據庫的個體參與者數據進行的綜合分析發現，酒精攝入與卒中、冠狀動脈疾病（CAD）、心力衰竭、致命性高血壓疾病和致命性主動脈瘤的風險呈線性相關，每100克/週酒精攝入量的風險比分別為1.14、1.06、1.09、1.24和1.15。 ⁸² 一項孟德爾隨機化統合分析發現，攜帶乙醇脫氫酶1B（ADH1B）變異等位基因的人群…戒酒率較高、飲酒量較低、酗酒發生率較低的人群，患冠心病（比值比 [OR] 0.90，95% 置信區間 [CI] 0.84-0.96)和腦卒中90% CI 0.72-0.95）的風險顯著降低。 ⁷⁸ 約40-50%的台灣人攜帶乙醛脫氫酶-2 (ALDH2) 功能異常等位基因（ALDH2*2 變異體），飲酒的潛在有害影響可能更為顯著。 ⁸³ ALDH2*2 功能異常等位基因會延緩飲酒後乙醛的代謝，導致「亞洲酒精潮紅症候群」或「酒精不耐受症候群」。 ^84,85 事實上，飲酒與許多急性和慢性疾病有關，並被認為是其中一些疾病負擔的主要危險因子。 ^86,87 基於越來越多的證據表明飲酒的有害影響台灣國家健康署建議，無飲酒習慣者應避免因任何原因開始飲酒。 ⁸⁸ 建議男性每週飲酒量少於100克（14克/天或1杯），女性少於50克（7克/天或0.5杯）（一杯標準飲品約含14克純酒精）。攜帶ALDH2*2功能異常等位基因者強烈建議戒酒。若攜帶ALDH2*2功能異常等位基因者無法避免飲酒，則建議男性每週飲酒量少於64克（9克/天或4杯），女性少於28克（4克/天或2杯）。 ⁸⁹ 應嚴格避免酗酒，酗酒定義為男性2小時內飲用5杯，女性2小時內飲用4杯。

建議：無飲酒習慣者應避免任何原因開始飲酒。 （證據等級 I，證據等級 C）。對於未攜帶 ALDH2*2 功能異常等位基因的男性，每週飲酒量應限制在 100 克以下（14 克/天或 1 杯/天），女性應限制在 50 克以下（7 克/天或 0.5 杯/天）。 （證據等級 I，證據等級 A）。對於攜帶 ALDH2*2 功能異常等位基因的男性，每週飲酒量應限制在 64 克以下（9 克/天或 4 杯/週），女性應限制在 28 克以下（4 克/天或 2 杯/週）。 （證據等級 IIa，證據等級 B）。應嚴格避免酗酒，酗酒定義為男性在 2 小時內飲用 5 杯，女性在 2 小時內飲用 4 杯。 （證據等級 I，證據等級 C）（一杯標準飲品含 14 克純酒精）

Alcohol

Alcohol intake is associated with an increase in HDL-C, but the relation between alcohol consumption and ASCVD is controversial.73,74 Although some studies suggest that low levels of alcohol consumption is associated with a decreased CV risk and diabetes,75e77 many other studies have challenged this view.78e81 More recently, in a combined analysis of individual-participant data from 3 large-scale databases in 19 high-income countries (the Emerging Risk Factors Collaboration, EPIC-CVD, and the UK Biobank), alcohol consumption was linearly associated with an increased risk of stroke, CAD, heart failure, fatal hypertensive disease, and fatal aortic aneurysm, with hazard ratios per 100 g/week alcohol consumption of 1.14, 1.06, 1.09, 1.24, and 1.15, respectively.82 A Mendelian randomization meta-analysis found that alcohol dehydrogenase 1B (ADH1B) variant allele carriers who had higher abstention, lower alcohol consumption, and lower prevalence of binge drinking had a significantly decreased risk of CAD (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.84e0.96) and ischemic stroke (OR 0.83, 95% CI 0.72e0.95).78 The potential detrimental effect of alcohol drinking could be more pronounced in about 40e50% of Taiwanese who carry the aldehyde dehydrogenase-2 (ALDH2) dysfunctional allele (ALDH2*2 variant).83 The ALDH2*2 dysfunctional allele delays acetaldehyde metabolism following alcohol consumption and leads to “Asian alcohol flushing syndrome” or “alcohol intolerance syndrome”.84,85 Actually, alcohol use has been related to many acute and chronic diseases and is recognized as a leading risk factor for the burden of some of these diseases.86,87 Based on the growing evidence for the detrimental effect of alcohol, the Taiwan Health Promotion Administration suggests individuals without a habit of drinking alcohol should avoid starting drinking for any reason.88 A limited alcohol consumption of <100 g/week (14 g/day or 1 drink/ day) for men and <50 g/week (7 g/day or 0.5 drink/day) for women is recommended (one standard drink Z 14 g pure alcohol). Alcohol abstention is strongly advised for those who carry the ALDH2*2 dysfunctional allele. If alcohol consumption is unavoidable in people carrying the ALDH2*2 dysfunctional allele, more limited alcohol consumption of <64 g/week (9 g/day or 4 drinks/week) for men and <28 g/ week (4 g/day or 2 drinks/week) for women is recommended.89 Binge drinking, defined as
5 drinks for men and
4 drinks for women within 2 h, should be strictly avoided

Recommendation People who do not have a habit of alcohol consumption should avoid starting drinking for any reason. (COR I, LOE C). Alcohol consumption should be limited to <100 g/ week (14 g/day or 1 drink/day) in men and <50 g/ week (7 g/day or 0.5 drink/day) in women without the ALDH2*2 dysfunctional allele. (COR I, LOE A). Alcohol consumption should be limited to <64 g/ week (9 g/day or 4 drinks/week) in men and <28 g/ week (4 g/day or 2 drinks/week) in women with the ALDH2*2 dysfunctional allele. (COR IIa, LOE B). Binge drinking, defined as
5 drinks for men and
4 drinks for women within 2 h, should be strictly avoided. (COR I, LOE C) (One standard drink Z 14 g pure alcohol)

2022-台灣高血脂初級預防指引- 11. 非藥物治療-運動

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

鍛鍊

關於運動對低密度脂蛋白膽固醇（LDL-C）的影響，現有證據仍有爭議。運動似乎無法顯著降低總膽固醇（TC）和低密度脂蛋白膽固醇（LDL-C）水平。 ⁶⁸ 高強度、大運動量的運動對降低三酸甘油酯（TG）和升高高密度脂蛋白膽固醇（HDL-C）濃度有明顯作用。 ⁶⁹ 規律運動可使三酸甘油酯濃度比不運動者降低17.7 mg/dL。 ⁷⁰ 一項大規模觀察性研究表明，規律慢跑有助於提高高密度脂蛋白膽固醇水平，降低三酸甘油酯水平和三酸甘油酯/高密度脂蛋白膽固醇比值。 ⁷¹ 其他有氧運動，如游泳、跳舞（包括國際標準舞）和騎自行車，也與高密度脂蛋白膽固醇水平升高有關。 ⁷¹ 儘管阻力運動對血脂譜的影響尚無定論，但由於其具有多種健康益處，包括改善身體功能和可能降低血壓，因此仍應鼓勵進行阻力運動。鼓勵所有成年人每週至少進行150分鐘的中等強度有氧運動，或每週進行75分鐘的高強度有氧運動，以降低動脈粥狀硬化性心血管疾病（ASCVD）的風險。 ⁵⁴ 即使是持續時間較短的5分鐘或10分鐘的運動，中間穿插1至2分鐘的休息，也與持續時間較長的運動一樣有益。 ⁷²

Exercise

Existing evidence on LDL-C response to exercises is controversial. It seems that exercise does not significantly reduce TC and LDL-C levels.68 There was an apparent effect on reduction of TG and increase of HDL-C concentrations with the high-amount and high-intensity exercise.69 Regular exercise can reduce TG by 17.7 mg/dL than those without exercise.70 A large-scale observational study showed that regular jogging contributed to an increase of HDL-C and reduction of TG and TG/HDL-C ratio.71 Other aerobic exercises such as swimming, dancing (including international standard dancing), and cycling were also associated with an elevated level of HDL-C.71 Although the changes in lipid profiles by resistance exercise are inconsistent, it should still be encouraged due to several health benefits, including improving physical functioning and possibly lowering blood pressure. All adults are encouraged to engage in at least 150 min per week of accumulated moderate-intensity aerobic physical activity, or 75 min per week of vigorousintensity aerobic physical activity to lower ASCVD risk.54 Even exercise with a shorter duration of 5 or 10 min with 1- to 2-min interruption is as beneficial as the longer ones.72

2022-台灣高血脂初級預防指引- 10. 非藥物治療-補充膳食(健康食品)

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

膳食補充劑 

一些膳食補充劑被認為有益於健康。

魚油或海洋ω-3脂肪酸補充劑可劑量依賴性地降低三酸甘油酯（TG），這主要歸因於二十碳五烯酸（EPA）和二十二碳六烯酸（DHA）的作用，但對總膽固醇（TC）、低密度脂蛋白膽固醇（LDL-C）或高密度脂蛋白膽固醇（HDL-C）沒有明顯影響。 

紅麴萃取物已被用作降低膽固醇的營養保健品。在紅麴發酵過程中，主要生物活性化合物莫納可林K是一種弱的可逆性3-羥基-3-甲基戊二醯輔酶A（HMG-CoA）還原酶抑制劑。一項統合分析研究表明，每日服用1200毫克至4800毫克紅麴米（RYR）可使低密度脂蛋白膽固醇（LDL-C）水平較安慰劑組降低18.4毫克/分升。 然而，市面上紅麴產品品質參差不齊，且可能存在潛在的藥物交互作用風險，其安全性尚未充分研究。

可可製品中的黃酮類化合物可抑制膽固醇吸收。一項統合分析顯示，食用黑巧克力2至12週可顯著降低總膽固醇（TC）和低密度脂蛋白膽固醇（LDL-C）水平（分別降低6.2毫克/分升和5.9毫克/分升）。 然而，令人擔憂的是，黑巧克力製品中飽和脂肪和添加糖的含量各不相同。

維生素D可能透過調節維生素D受體和胰島素誘導基因2（IG2）的轉錄活性來影響循環膽固醇水平，IG2抑制HMG-CoA還原酶的表達。 臨床研究表明，補充維生素D有助於降低總膽固醇（TC）、低密度脂蛋白膽固醇（LDL-C）和三酸甘油酯（TG）水平，但對高密度脂蛋白膽固醇（HDL-C）水平無影響。

一項包含14項隨機對照試驗的統合分析顯示，飲用綠茶或其萃取物可適度降低TC和LDL-C濃度，但對HDL-C無影響。 然而，一項為期6年的縱向隊列研究表明，經常飲茶（包括紅茶和綠茶）與HDL-C濃度隨年齡增長而下降的速度減緩相關。

Dietary supplements Some dietary supplements are considered to be beneficial for health. Fish oil, or marine omega-3 fatty acid supplementation, yields a dose-dependent reduction in TG from the effect of eicosapentenoic acid (EPA) and docosahexenoic acid (DHA), but no overt changes in TC, LDL-C or HDL-C.60,61 Red yeast rice (RYR) extract has been applied as a cholesterol-lowering nutraceutical. During the rice fermentation, the main bioactive compound, monacolin K, is a weak reversible inhibitor of 3-hydroxy-3- methylglutaryl-coenzyme A (HMG-CoA) reductase. In a metaanalysis study, using RYR from 1200 mg/day to 4800 mg/ day, LDL-C was lowered with 18.4 mg/dL compared to placebo.62 However, the quality of RYR products in the market varied and RYR may possess a potential risk of pharmacological interactions and its safety outcomes have not been extensively studied yet. The flavonoids in cocoa products inhibit cholesterol absorption. A meta-analysis showed that consumption of dark chocolate for 2e12 weeks significantly reduced TC and LDL-C (6.2 and 5.9 mg/ dL), respectively.63 Nonetheless, it is a concern that dark chocolate products contained varied amount of saturated fats and added sugar. Vitamin D may affect circulating cholesterol levels by modulating the transcription activity of vitamin D receptor and insulin-induced gene-2 activity which inhibits HMG-CoA reductase expression.64,65 Clinical study indicated that vitamin D supplementation has benefits on reducing TC, LDL-C, and TG but no influence on HDLC level.64 A meta-analysis of 14 randomized controlled trials showed that consumption of green tea or its extracts resulted in a moderate reduction in TC and LDL-C concentrations, but no change in HDL-C.66 However, a longitudinal cohort study with 6-year follow-up showed that frequent tea consumption, including black tea and green tea, was associated with a slower age-related decrease in HDL-C concentrations.67

2022-台灣高血脂初級預防指引- 9. 非藥物治療-飲食

2025-12-09 11:08AM

2022台灣血脂治療指引(2022指引只有英文版-無中文版)
下面中文使用google自動翻譯

非藥物療法包括下面六項

1. Diet 飲食

2. Dietary supplements 營養補充

3. Exercise 運動

4. Alcohol 酒精

5. Cigarette smoking 抽菸

6. Healthy lifestyle 生活習館

非藥物療法
飲食
多項觀察性和隨機臨床研究表明，健康的飲食模式與較低的動脈粥樣硬化性心血管疾病 (ASCVD) 風險相關，例如地中海飲食、DASH（膳食療法控制高血壓）飲食、台灣健康飲食 (TEA) 和台灣素食。


台灣飲食模式研究也指出，油炸食品、甜食和含糖飲料、高脂肪和高糖糕點、肥肉和動物內臟是心血管代謝疾病的危險食物。


基於這些研究，一種有益心臟健康的飲食模式包括：
富含植物性食物，例如全穀物、蔬菜、新鮮水果、堅果和種子、茶以及富含不飽和脂肪酸的非熱帶植物油（例如大豆油、葵花籽油、橄欖油）；
富含ω-3脂肪酸的食物（例如魚類、大豆、豆類）；
低反式脂肪、油炸食品、肥肉、加工肉類或魚類製品（例如香腸、培根、火腿和熱狗）以及添加糖/精製糖的攝取量應較低。


統合分析表明，低碳水化合物飲食可能有助於減輕體重並改善高密度脂蛋白膽固醇 (HDL-C) 和三酸甘油酯 (TG) 水平。 然而，低密度脂蛋白膽固醇 (LDL-C) 和總膽固醇 (TC) 升高的潛在後果是一個主要問題。


在過去幾十年，雞蛋攝取量與動脈粥狀硬化性心血管疾病 (ASCVD) 發生之間的關聯性已得到證實，但仍存在爭議。雞蛋不僅飽和脂肪酸含量低，而且富含蛋白質和各種微量營養素，這些營養素已被證明可以促進大分子 LDL-C 的形成，而大分子 LDL-C 的致動脈粥樣硬化作用較弱。 由於可能仍存在中等的劑量反應關係，因此應根據個人的 LDL-C 目標值和營養狀況來調整雞蛋的攝取量。


此外，乳製品攝取的影響也存在爭議，因為先前的研究發現飽和脂肪酸含量會增加低密度脂蛋白膽固醇（LDL-C）水平。 近期的一些統合分析顯示，乳製品攝取對心血管結局的影響可能是正面的，也可能是中性的，而一項台灣的前瞻性研究則顯示乳製品具有保護作用。乳製品，包括發酵乳製品以及最好是脫脂或低脂乳製品，可以作為健康飲食的一部分適量食用。

Non-pharmacological therapy
Diet
Several observational and randomized clinical studies have demonstrated association between a lower risk of ASCVD and healthy dietary patterns, such as Mediterranean diet, DASH (Dietary Approaches to Stop Hypertension) diet, healthy Taiwanese eating approach (TEA), and Taiwanese vegetarian diet. Taiwanese dietary pattern studies also identified fried foods, sweets and sweetened beverages, high fat and sugar-containing pastry, fatty and organ meats as risky foods for cardiometabolic diseases.47,49 Based on these studies, a cardioprotective dietary pattern includes: rich plant-based foods including whole grains, vegetables, fresh fruits, nuts and seeds, tea, and unsaturated fatty acid-rich non-tropical plant oils (e.g., soybean oil, sunflower oil, olive oil); sources of omega-3 fatty acids (e.g., fish, nuts, legumes); good protein foods (low degree processed soy product, fish, egg, and lean animal protein); low in trans-fats, fried foods, fatty meat, processed meats or fish products (e.g., sausage, bacon, ham and hot dogs), and added/refined sugars.50e54 Meta-analysis indicated that low-carbohydrate diets may help weight loss and improve HDL-C and TG levels.55 However, the potential consequence of elevated LDL-C and total cholesterol (TC) is a major concern. In the past decades, the modest association between eggs consumption and the development of ASCVD has been established but remains controversial. Eggs are not only low in saturated fatty acid but also rich in protein and various micronutrients, which have been shown to promote the formation of large LDL-C, which is less atherogenic.56,57 Since there may still be a moderate doseeresponse relationship, the appropriate amount of egg consumption should be individualized based on individual’s LDL-C target and nutrition status. Besides, the effect of dairy consumption is also controversial due to previous observation relating the saturated fatty acid content to increase LDL-C levels.58 Recent meta-analyses revealed either positive or neutral effects on CV outcomes from consumption of dairy products, while a Taiwanese prospective study showed protective association.47 Dairy, including fermented and preferably no-fat or low-fat products, may be consumed moderately as part of a healthy diet.59


Dietary supplements Some dietary supplements are considered to be beneficial for health. Fish oil, or marine omega-3 fatty acidsupplementation, yields a dose-dependent reduction in TG from the effect of eicosapentenoic acid (EPA) and docosahexenoic acid (DHA), but no overt changes in TC, LDL-C or HDL-C.60,61 Red yeast rice (RYR) extract has been applied as a cholesterol-lowering nutraceutical. During the rice fermentation, the main bioactive compound, monacolin K, is a weak reversible inhibitor of 3-hydroxy-3- methylglutaryl-coenzyme A (HMG-CoA) reductase. In a metaanalysis study, using RYR from 1200 mg/day to 4800 mg/ day, LDL-C was lowered with 18.4 mg/dL compared to placebo.62 However, the quality of RYR products in the market varied and RYR may possess a potential risk of pharmacological interactions and its safety outcomes have not been extensively studied yet. The flavonoids in cocoa products inhibit cholesterol absorption. A meta-analysis showed that consumption of dark chocolate for 2e12 weeks significantly reduced TC and LDL-C (6.2 and 5.9 mg/ dL), respectively.63 Nonetheless, it is a concern that dark chocolate products contained varied amount of saturated fats and added sugar. Vitamin D may affect circulating cholesterol levels by modulating the transcription activity of vitamin D receptor and insulin-induced gene-2 activity which inhibits HMG-CoA reductase expression.64,65 Clinical study indicated that vitamin D supplementation has benefits on reducing TC, LDL-C, and TG but no influence on HDLC level.64 A meta-analysis of 14 randomized controlled trials showed that consumption of green tea or its extracts resulted in a moderate reduction in TC and LDL-C concentrations, but no change in HDL-C.66 However, a longitudinal cohort study with 6-year follow-up showed that frequent tea consumption, including black tea and green tea, was associated with a slower age-related decrease in HDL-C concentrations.67

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)

2022-台灣高血脂初級預防指引- 7. LDL目標值-中度風險民眾

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

中度風險（≥2個風險因子）：根據專家共識，對於具有2個風險因子的受試者，啟動治療和治療目標的LDL-C水準為115 mg/dL。此建議的LDL-C水平與2019年ESC血脂指引中建議的低風險族群LDL-C目標值<116 mg/dL相近。 ¹⁸ 建議的LDL-C目標值115 mg/dL低於日本和韓國血脂指引中的數值，日本指引中中度風險族群的LDL-C目標值為<140 mg/dL，韓國指引中具有2個或以上主要風險因子族群的LDL-C目標值為<130 mg/dL。 ^39,40 如果在生活方式調整3個月後，LDL-C水平仍高於目標值，則首先考慮使用中等強度的他汀類藥物。

建議：對於具有 2 項危險因子且 LDL-C ≥ 115 mg/dL 的受試者，應開始非藥物治療，LDL-C 目標值為 < 115 mg/dL。 （證據等級 IIa，證據等級 C）如果非藥物治療 3 個月後仍未達到治療目標，則應考慮中等強度他汀類藥物治療。 （證據等級 IIa，證據等級 C）

Moderate risk (‡2 risk factors) The LDL-C level for initiation of therapy and treatment target in subjects with
2 risk factors is 115 mg/dL based on the experts’ consensus. This recommended LDL-C level is close to the 2019 ESC lipid guidelines suggesting the LDLC target <116 mg/dL in the low risk individuals.18 The recommended LDL-C target of 115 mg/dL is lower than that in the Japanese and Korean lipid guidelines where the LDLC target is <140 mg/dL for moderate risk in Japan and <130 mg/dL for those with 2 or more major risk factors in Korea.39,40 Moderate-intensity statins are considered first if LDL-C remains higher than the target after 3 months of lifestyle adjustment.

Recommendation In subjects with
2 risk factors and LDL-C
115 mg/ dL, non-pharmacological therapy should be initiated and the LDL-C target is <115 mg/dL. (COR IIa, LOE C) If the treatment target is not met after 3 months of non-pharmacological therapy, moderate-intensity statin therapy should be considered (COR IIa, LOE C)