近日，美國國家脂質協會(NLA)發表了相關專家小組編寫的《以患者為中心的血脂異常管理建議(第2部分)》，全文正式在線發表於《臨床脂質學雜誌》(Journal of Clinical Lipidology)和NLA官網。

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該建議加強了以生活方式幹預為血脂管理基礎的重要性，新增了心血管健康所需的飲食、飲食模式的特定變化，體力活動量以及運動量的詳細建議。

該建議還突出了在特殊人群中致動脈粥樣化膽固醇水平管理的重要性，包括不同民族及種族人群各階段(從兒童到老年，從懷孕到更年期)，以及其他與心血管風險增加有關的情況，包括HIV疾病和類風濕性關節炎人群。

此外，該建議的其他推薦內容包括以下幾點。

1、 在進行生活方式幹預後，對那些心血管風險增加的人群(包括HIV/AIDS和類風濕性關節炎，基於種族和人種存在風險的人群)，應選擇他汀類藥物治療。

2、 少數種族及民族的肥胖、代謝綜合征和糖尿病的發病率增加，需積極幹預生活方式。

3、 動脈粥樣硬化常在生命早期即開始並隨時間進展，因此為了長期心血管健康，在較為年輕個體中降低致動脈粥樣化膽固醇水平是重要的。

4、 鑒於生活方式幹預和降脂藥治療依從性非常重要，因此NLA倡議：在患者每次來診時與其討論依從性以發現問題掃除治療障礙;將血脂水平和脂蛋白目標持續反饋給患者;包括醫生和護士等的健康管理團隊幫助患者提高依從性。

5、對接受了最大耐受劑量他汀治療後膽固醇仍控製不達標的高危患者，可考慮添加其他降脂藥。

參考文獻：Terry A. Jacobson,et al. Journal of Clinical Lipidology. 10.1016/j.jacl.2015.09.002

Part Two Provides New Recommendations for Managing Cholesterol in Diverse and Underrepresented Ethnic and Racial Groups Along with Recommendations that Cross the Life Span from Children to Seniors with Lifestyle Therapies as Foundation

Pittsburgh — Today, the National Lipid Association (NLA) published its Part Two Recommendations based on a panel of independent experts, available now on theJournal of Clinical Lipidologywebsite.

Part Two of the NLA Recommendations reinforce the importance of lifestyle changes as the cornerstone of therapy in cholesterol management, and provide new detailed advice for specific changes in diet, dietary patterns and the amount of physical activity and exercise required for cardiovascular health.

In addition, the recommendations highlight the importance of managing atherogenic cholesterol levels in special populations, including diverse ethnic and racial groups such as African Americans, Hispanics and South Asians, throughout the life span from children to seniors, including women from pregnancy to menopause, and other conditions associated with increased cardiovascular risk, including HIV disease and rheumatoid arthritis.

Additional highlights from the recommendations include these:

• After lifestyle therapy, statins remain the drug therapy of choice for those with increased cardiovascular risk conditions, including HIV/AIDS and rheumatoid arthritis, and those at risk based on ethnicity or race, such as African Americans and South Asians.
• Increased rates of obesity, metabolic syndrome and diabetes in ethnic and racial minorities are of great concern, and aggressive efforts in lifestyle control are needed to combat this growing public health problem.
• Atherosclerosis often begins early in life and progresses for decades, so reducing atherogenic cholesterol in younger individuals such as children and adolescents is important for long-term cardiovascular health.
• Given the importance of adherence to both lifestyle therapies and lipid-lowering medication, the NLA advocates: 1) discussion of adherence at each patient visit to identify problems, barriers or side effects of therapy; 2) continuous feedback to patients about their non-HDL-C and LDL cholesterol levels and goals of these lipoproteins and 3) the incorporation, whenever possible, of an interdisciplinary team of healthcare providers—including nurses, nurse practitioners, clinical pharmacists, physician assistants and registered dietitian nutritionists—to assist patients with adherence issues.
• For high-risk patients not at their atherogenic cholesterol goals while on a maximally tolerated statin dose, consideration should be given to adding non-statin lipid-altering therapies (e.g., ezetimibe) for further lowering of atherogenic cholesterol.

The NLA Recommendations are meant to serve as a guide for healthcare providers in the diagnosis and treatment of lipid disorders and are intended to provide additional expert guidance to currently available guidelines for the treatment of high blood cholesterol. The recommendations are also intended to assist clinicians in patient management in areas that have not been addressed in previous guidelines. The final version of Part Two is now published in the Journal of Clinical Lipidology (JCL).

“The NLA Part Two Recommendations build on our previous NLA Recommendations Part One,” said Dr. Carl Orringer, MD, president, National Lipid Association and associate professor of medicine at the University of Miami Miller School of Medicine. “We are excited to provide a comprehensive set of recommendations in the management of lipid and lipoprotein-related cardiovascular risk that may aid clinicians and patients in making better clinical decisions using a patient-centered approach.”