PDF(Pubmed)
Abstract：
Atherosclerotic cardiovascular disease (ASCVD) is epidemic throughout the world and is etiologic for such acute cardiovascular events as myocardial infarction, ischemic stroke, unstable angina, and death. ASCVD also impacts risk for dementia, chronic kidney disease peripheral arterial disease and mobility, impaired sexual response, and a host of other visceral impairments that adversely impact the quality and rate of progression of aging. The relationship between low-density lipoprotein cholesterol (LDL-C) and risk for ASCVD is one of the most highly established and investigated issues in the entirety of modern medicine. Elevated LDL-C is a necessary condition for atherogenesis induction. Basic scientific investigation, prospective longitudinal cohorts, and randomized clinical trials have all validated this association. Yet despite the enormous number of clinical trials which support the need for reducing the burden of atherogenic lipoprotein in blood, the percentage of high and very high-risk patients who achieve risk stratified LDL-C target reductions is low and has remained low for the last thirty years. Atherosclerosis is a preventable disease. As clinicians, the time has come for us to take primordial and primary prevention more serously. Despite a plethora of therapeutic approaches, the large majority of patients at risk for ASCVD are poorly or inadequately treated, leaving them vulnerable to disease progression, acute cardiovascular events, and poor aging due to loss of function in multiple visceral organs. Herein we discuss the need to greatly intensify efforts to reduce risk, decrease disease burden, and provide more comprehensive and earlier risk assessment to optimally prevent ASCVD and its complications. Evidence is presented to support that treatment should aim for far lower goals in cholesterol management, should take into account many more factors than commonly employed today and should begin significantly earlier in life.
摘要：
动脉粥样硬化性心血管疾病（ASCVD）在全世界范围内流行，是心肌梗死等急性心血管事件的病因。缺血性卒中,不稳定型心绞痛,和死亡。ASCVD也会影响痴呆症的风险，慢性肾脏病外周动脉疾病和运动，性反应受损,以及许多其他内脏损伤，对衰老的质量和速度产生不利影响。低密度脂蛋白胆固醇（LDL-C）与ASCVD风险之间的关系是整个现代医学中最高度确定和研究的问题之一。LDL-C升高是动脉粥样硬化诱导的必要条件。基础科学调查,前瞻性纵向队列，和随机临床试验都验证了这种关联.然而，尽管有大量的临床试验支持需要减少血液中动脉粥样硬化脂蛋白的负担，实现危险分层LDL-C目标降低的高危和极高危患者的百分比较低,并且在过去30年中一直较低.动脉粥样硬化是一种可预防的疾病。作为临床医生,现在是我们更加认真地采取原始和初级预防的时候了。尽管治疗方法过多，大多数有ASCVD风险的患者治疗不良或不充分，让他们容易受到疾病进展的影响，急性心血管事件，以及由于多个内脏器官功能丧失而导致的不良老化。在这里，我们讨论了需要大大加大力度降低风险，减轻疾病负担，并提供更全面和更早的风险评估，以最佳地预防ASCVD及其并发症。提供的证据支持治疗应该针对低得多的胆固醇管理目标，应该考虑比今天普遍使用的更多的因素，并且应该在生命的早期开始。
