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血脂异常是最为重要的心血管病危险因素之一。近年的临床研究表明,在无心血管病的中危人群中应用他汀一级预防可以显著降低心血管事件风险;中国择期经皮冠状动脉介入术(PCI)患者术前序贯他汀治疗未能进一步改善临床预后。在他汀治疗的基础上,联用依折麦布或前蛋白转化酶枯草溶菌素9(PCSK-9)抑制剂降低低密度脂蛋白胆固醇(LDL-C)能进一步减少主要不良心血管事件;联用贝特类或烟酸虽能显著降低三酰甘油、升高高密度脂蛋白胆固醇(HDL-C)水平却未显示出明确的心血管临床获益。胆固醇酯转运蛋白(CETP)抑制剂虽能显著升高HDL-C,但未能使主要心血管终点事件减少。这些临床研究不仅为血脂领域的临床实践提供了循证医学新证据,也对血脂管理策略的制定具有积极的指导意义。
Dyslipidemia is one of the most important cardiovascular risk factors. In recent years, clinical studies have shown that the primary prevention of statins in critically ill patients without cardiovascular disease can significantly reduce the risk of cardiovascular events; preoperative sequential statin therapy in Chinese patients undergoing elective PCI fails to further improve Clinical prognosis. Based on statin therapy, the combination of ezetimibe or a proprotein convertase PCSK-9 inhibitor to lower LDL-C further reduces major adverse cardiovascular events; Although fibrates or niacin significantly reduced triglycerides, elevated HDL-C levels did not show a clear cardiovascular benefit. Although cholesteryl ester transfer protein (CETP) inhibitors significantly increased HDL-C, they did not reduce the major cardiovascular events. These clinical studies not only provide evidence-based evidence of clinical practice in the field of blood lipids, but also have a positive guiding significance for the formulation of lipid management strategies.