合并症患者的血脂异常管理--面对挑战。

IF 5.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal - Cardiovascular Pharmacotherapy Pub Date : 2024-11-06 DOI:10.1093/ehjcvp/pvae058
Gert Mayer, Dobromir Dobrev, Juan Carlos Kaski, Anne Grete Semb, Kurt Huber, Andreas Zirlik, Stefan Agewall, Heinz Drexel
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引用次数: 0

摘要

血脂异常是一种常见的慢性肾病(CKD),也是导致心血管死亡率过高的原因之一。其病理生理学十分复杂,并受合并症(如是否存在蛋白尿、糖尿病或药物治疗)的影响。本文概述了目前可用的治疗方案。我们重点关注患有慢性肾脏病的患者,但不包括接受肾脏替代疗法(血液透析、腹膜透析或肾移植)的患者。他汀类药物的使用是安全的,建议大多数患者使用,但关于低密度脂蛋白(LDL)胆固醇目标的指南各不相同。虽然目前还没有专门针对原蛋白转化酶枯草酶/kexin 9 型抑制剂的一级或二级预防研究,但对大型结果试验进行的二级分析表明,存在 CKD 对终点的影响没有改变。贝门冬氨酸也有类似的数据,但无法就其疗效和安全性得出明确结论。目前还没有关于 inclisiran 的结果试验,而其降低胆固醇的效果似乎不受 CKD 的影响。最后,纤维素类药物和 icosapent ethyl 在 CKD 中的价值尚不明确。血脂异常是导致慢性肾脏病患者患心血管疾病的主要原因。使用他汀类药物(最有可能是 PCSK9 抑制剂)降低低密度脂蛋白胆固醇可降低事件发生率,因此几乎所有患者都应开始他汀类药物治疗。目前,其他干预措施(贝贝多酸、埃克替西兰、纤维酸盐或伊可新戊酯)在处方前需要根据具体情况决定。
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Management of dyslipidaemia in patients with comorbidities: facing the challenge.

Dyslipidaemia is a common chronic kidney disease (CKD) and contributes to excessively elevated cardiovascular mortality. The pathophysiology is complex and modified by comorbidities like the presence/absence of proteinuria, diabetes mellitus or drug treatment. This paper provides an overview of currently available treatment options. We focused on individuals with CKD and excluded those on renal replacement therapy (haemodialysis, peritoneal dialysis, or kidney transplantation). The use of statins is safe and recommended in most patients, but guidelines vary with respect to low-density lipoprotein (LDL) cholesterol goals. While no dedicated primary or secondary prevention studies are available for pro-protein convertase subtilisin/kexin type 9 inhibitors, secondary analyses of large outcome trials reveal no effect modification on endpoints by the presence of CKD. Similar data have been shown for bempedoic acid, but no definite conclusion can be drawn with respect to efficacy and safety. No outcome trials are available for inclisiran while the cholesterol lowering effects seem to be unaffected by CKD. Finally, the value of fibrates and icosapent ethyl in CKD is unclear. Lipid abnormalities contribute to the massive cardiovascular disease burden in CKD. Lowering of LDL cholesterol with statins (and most likely PCSK9 inhibitors) reduces the event rate and thus statin therapy should be initiated in almost all individuals. Other interventions (bempedoic acid, inclisiran, fibrates, or icosapent ethyl) currently need a case-by-case decision before prescription.

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来源期刊
European Heart Journal - Cardiovascular Pharmacotherapy
European Heart Journal - Cardiovascular Pharmacotherapy Medicine-Cardiology and Cardiovascular Medicine
CiteScore
10.10
自引率
14.10%
发文量
65
期刊介绍: The European Heart Journal - Cardiovascular Pharmacotherapy (EHJ-CVP) is an international, peer-reviewed journal published in English, specifically dedicated to clinical cardiovascular pharmacology. EHJ-CVP publishes original articles focusing on clinical research involving both new and established drugs and methods, along with meta-analyses and topical reviews. The journal's primary aim is to enhance the pharmacological treatment of patients with cardiovascular disease by interpreting and integrating new scientific developments in this field. While the emphasis is on clinical topics, EHJ-CVP also considers basic research articles from fields such as physiology and molecular biology that contribute to the understanding of cardiovascular drug therapy. These may include articles related to new drug development and evaluation, the physiological and pharmacological basis of drug action, metabolism, drug interactions, and side effects.
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