血脂异常是指血脂成分的不健康变化,是动脉粥样硬化性心血管疾病(ASCVD)的危险因素。通常,低密度脂蛋白胆固醇(LDL-C)是血脂异常管理的主要目标。然而,非高密度脂蛋白胆固醇(non-HDL-C)作为一种替代品,可靠的目标。它包括所有血浆脂蛋白,如LDL,富含甘油三酯的脂蛋白(TRL),TRL-残余物,和脂蛋白a[Lp(a)],高密度脂蛋白(HDL)除外。除了LDL-C,据报道,非HDL-C的其他几种成分具有动脉粥样硬化,帮助动脉粥样硬化的病理生理学。它们被认为是LDL-C水平受控的他汀类药物治疗患者中存在的残余ASCVD风险的贡献者。因此,non-HDL-C现在被认为是CVD的独立危险因素或预测因子.非HDL-C的流行归因于其易于估计和不依赖于空腹状态。它也能更好地预测接受他汀类药物治疗的患者的ASCVD风险,和/或肥胖的人,糖尿病,和代谢紊乱。此外,大型随访研究报告,较年轻(<45岁)时基线非HDL-C水平较高的个体在年龄较大时更容易发生不良CVD事件,表明非HDL-C的长期预测能力。因此,大多数国际指南建议将非HDL-C作为血脂异常治疗的次要目标.有趣的是,最近流行病学研究的地理模式显示,在高危国家,非HDL-C归因死亡率非常高.这篇综述强调了非HDL-C在ASCVD发病机制和预后中的独立作用。此外,讨论了在社区/人口层面采用针对国家的血脂异常管理方法的必要性.总的来说,非HDL-C可成为血脂异常管理的共同或首要目标.
Dyslipidemia refers to unhealthy changes in blood lipid composition and is a risk factor for atherosclerotic cardiovascular diseases (ASCVD). Usually, low-density lipoprotein-cholesterol (LDL-C) is the primary goal for dyslipidemia management. However, non-high-density lipoprotein cholesterol (non-HDL-C) has gained attention as an alternative, reliable goal. It encompasses all plasma lipoproteins like LDL, triglyceride-rich lipoproteins (TRL), TRL-remnants, and lipoprotein a [Lp(a)] except high-density lipoproteins (HDL). In addition to LDL-C, several other constituents of non-HDL-C have been reported to be atherogenic, aiding the pathophysiology of atherosclerosis. They are acknowledged as contributors to residual ASCVD risk that exists in patients on statin therapy with controlled LDL-C levels. Therefore, non-HDL-C is now considered an independent risk factor or predictor for CVD. The popularity of non-HDL-C is attributed to its ease of estimation and non-dependency on fasting status. It is also better at predicting ASCVD risk in patients on statin therapy, and/or in those with obesity, diabetes, and metabolic disorders. In addition, large follow-up studies have reported that individuals with higher baseline non-HDL-C at a younger age (<45 years) were more prone to adverse CVD events at an older age, suggesting a predictive ability of non-HDL-C over the long term. Consequently, non-HDL-C is recommended as a secondary goal for dyslipidemia management by most international guidelines. Intriguingly, geographical patterns in recent epidemiological studies showed remarkably high non-HDL-C attributable mortality in high-risk countries. This
review highlights the independent role of non-HDL-C in ASCVD pathogenesis and prognosis. In addition, the need for a country-specific approach to dyslipidemia management at the community/population level is discussed. Overall, non-HDL-C can become a co-primary or primary goal in dyslipidemia management.