《冠心病合并糖尿病的调脂策略》课件.ppt

更新的指南认为对高危患者来说，胆固醇水平越低越有利，NCEP的专家小组建议: 1. 冠心病高危患者（确诊为冠心病或脑血管病、糖尿病或者有两个以上心血管病危险因素的人（10年内发生冠心病的风险20%） ）LDL胆固醇的治疗目标是100mg/dl。 2.对极高危患者（确诊冠心病并合并多个危险因素，包括糖尿病、代谢综合征或严重的未控制的危险因素）来说，建议的胆固醇控制目标更低，LDL胆固醇应控制在70mg/dl的水平。即使极高危患者LDL胆固醇水平100mg/dl，指南也建议将它降到70mg/dl以下。 ? 3.对中危患者——有两个或以上冠心病危险因素的患者（10年发生冠心病的风险是10%～20%）——NCEP将LDL胆固醇控制目标保持在130mg/dl，但是医生可以将治疗目标定在100mg/dl。 Grundy SM et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines.Circulation. 2004 Jul 13;110(2):227-39. Treatment Strategies for Diabetic Dyslipidemia According to the American Diabetes Association (ADA), the primary strategy in the treatment of diabetic dyslipidemia is to lower low-density lipoprotein (LDL) cholesterol, and the secondary strategy is to raise high-density lipoprotein (HDL) cholesterol and lower triglycerides. In addition, there are a number of other approaches, including reducing non-HDL cholesterol, which will probably be adopted as a secondary target by the National Cholesterol Education Program (NCEP) in their Adult Treatment Panel III recommendations. A number of investigators believe that apolipoprotein (apo) B may be even a better target than LDL cholesterol, but the measurement of apo B is not sufficiently standardized, at least according to the NCEP. A number of individuals also think that remnants may be better predictors of CHD, but lack of standardization of measurement presents potential problems with this target as well. References: American Diabetes Association. Management of dyslipidemia in adults with diabetes. Diabetes Care 2000;23 (suppl 1):S57-S60. Chait A, Brunzell JD. Diabetes, lipids, and atherosclerosis. In: LeRoith D, Taylor SI, Olefsky JM, eds. Diabetes Mellitus: a Fundamental and Clinical Text. Philadelphia: Lippincott-Raven, 1996:772-779. European Diabetes Policy Group 1999. A desktop guide to Type 2 diabetes mellitus. Diabet Med 1999;16:716-730. Topic II (Case) - 2 Top