摘要
血胆固醇、低密度脂蛋白胆固醇(LDL-C)与冠心病的关系明确,呈线性正相关,是Framingham研究发现的西方国家冠心病的首位危险因素。目前其重要位置已扩展到所有动脉粥样硬化性心血管病,一直受到重视,近两年尤其受到关注,西方国家的指南、建议再三强调强化降脂,大剂量他汀类用药的必要性。然而亚洲人、中国人的遗传特点与西方国家不同,血胆固醇及LDL-C对于中国人的动脉粥样硬化性心血管疾病的影响并不像西方人那样重要,而是位于高血压、糖尿病和吸烟之后。中国人基础血胆固醇水平低于西方人,且对他汀类药物非常敏感,较小剂量即可达到白种人大剂量才能达到的效果,没有必要像白种人那样用大剂量他汀。我国的问题不是剂量要大,而是覆盖要广,提高我国年轻患者对血脂问题的知晓率、治疗率,而应相对降低对老年人血脂问题的关注度,因为老年人高胆固醇的危害并不大。我国2014年血脂专家共识没有追随西方国家的指南,提出"中国剂量"非常明智,指导临床医生明辨东方与西方,白种人与黄种人的差别,认真总结我国自己的经验,制定我国自己的共识、指南,指导我国的临床实践。
The relationship of blood cholesterol and LDL‐C with coronary heart disease is well established and has demonstrated a strong positive linear relationship .Framingham study first discovered that the relationship is the prime risk factor for coronary heart disease in Western countries . Currently its importance has extended to all atherolsclerotic cardiovascular diseases （ASCVD ） . Lowering cholesterol and LDL‐C , giving high dose statins has been emphasized strongly in the National Lipid Association recommendations or management guidelines in recent 2 years .Asian and Chinese are different from Westerners by heredity .Blood cholesterol and LDL‐C are not the number one risk factor for ASCVD among Chinese . It ranks after hypertension , DM and smoking . The basic cholesterol level in Chinese is lower than Westerners ,and the therapeutic effect of statins is better than that among the Westerners .Small dose of statins can achieve the same effect as larger doses among the Westerners .The problem in China is not the need of high dose of statins , but a wider awareness of its use .Increasing awareness and treatment for high cholesterol among young Chinese is more important now .At the same time ,the focus of attention on high cholesterol in elders should decrease since the damage caused by that is not so significant .In 2014 ,China＆#39;s experts in blood cholesterol did not totally follow Western clinical guidelines ,but pointed out the concept of ＆quot;Dosage for Chinese＆quot; is a good idea .This will reinforce the differences between Oriental and Western people ,and provide guidance to clinical physician in treating Chinese high cholesterol patients .
出处
《医学与哲学（B）》
2015年第3期23-27,共5页
Medicine & Philosophy(B)
作者简介
朱宁（1955-），女，浙江杭州人，教授，主任医师，研究方向：血脂、心力衰竭、老年病。
