老年高脂血癥

1、 起因分類起因分類 表型分類表型分類 基因分類基因分類 n 家族性高膽固醇血癥家族性高膽固醇血癥 n 家族性載脂蛋白家族性載脂蛋白B缺陷癥缺陷癥 n 家族性混合型高脂血癥家族性混合型高脂血癥 n 家族性異常家族性異常脂蛋白血癥脂蛋白血癥 n 家族性高甘油三酯血癥家族性高甘油三酯血癥 n 多基因家族性高膽固醇血癥多基因家族性高膽固醇血癥 n 家族性脂蛋白家族性脂蛋白(a)過多血癥過多血癥 TC=total cholesterol; CHD=coronary heart disease. Martin MJ et al. Lancet. 1986;2:933-936; Castelli WP. A

2、m J Med. 1984;76:4-12. TC (mg/dL) 6-year CHD incidence per 1000 men 295 0 25 50 75 100 125 150 Age-adjusted 6-year CHD mortality per 1000 men TC (mg/dL) 0 2 4 6 8 10 12 14 16 18 160200260300140180220 240280320 一千三百零一點(diǎn)一七億元人民幣一千三百零一點(diǎn)一七億元人民幣 不穩(wěn)定不穩(wěn)定 斑塊斑塊 破裂斑塊破裂斑塊 內(nèi)膜增厚內(nèi)膜增厚 動(dòng)脈粥樣化動(dòng)脈粥樣化 形成形成 正常動(dòng)脈正常動(dòng)脈內(nèi)皮功能不全內(nèi)

3、皮功能不全 55years70years Quartile (mmol L1) MeanTotal number Number of events RR (95% CI) Total number Number of events RR (95% CI) Men 0.90.84496261.0020291.00 1.01.11.05664391.09 (0.661.79)258161.29 (0.562.93) 1.21.31.24615351.09 (0.651.83)224171.70 (0.753.88) 1.31.6167817 0.47 (0.250.89) 26410 0.82 (

4、0.322.09) per 0.1mmolL1 increase 24531170.91 (0.860.98)948520.96 (0.871.05) Women 1.21.061152361.00587261.00 1.31.41.35859190.70 (0.401.24)395110.54 (0.261.13) 1.51.61.55694110.57 (0.291.13)29270.51 (0.221.19) 1.61.93848100.44 (0.220.91)358100.62 (0.291.32) per 0.1mmolL1 increase 3553760.89 (0.80.96

5、)163254 0.90 (0.830.98) 55years70years Quartile (mmol L1) MeanTotal number Number of events RR (95% CI) Total number Number of events RR (95% CI) Men 3.32.7600131.0027271.00 3.44.33.9666332.34 (1.224.47)27916 2.25 (0.925.52) 4.45.34.8532302.80 (1.445.44)188153.27 (1.318.15) 5.36.6655413.24 (1.696.19

6、)209143.06 (1.187.91) per unit increase 24531171.16 (1.051.28)948521.16 (1.011.33) Women 2.82.381181.0035971.00 2.93.83.41021151.45 (0.613.43)474121.29 (0.513.29) 3.94.84.3844141.43 (0.593.48)37680.90 (0.312.57) 4.86.3877394.00 (1.858.65)423273.24 (1.407.53) per unit increase 3553761.25 (1.161.36)16

7、32541.37 (1.201.56) 47 n0 n50 n100 n150 n200 n250 n新生兒n青春期n50Y nMen nWomen n70Yn70Y Change in lipid levels with age Changes in plasma LDL- and HDL-cholesterol concentrations with age in men and women. LDL- cholesterol levels rise with age; this effect is initially more prominent in men but, by age 7

8、0, LDL- cholesterol levels are higher in women. Data from: Heiss G, Tamir I, Davis CE, et al, Circulation, 1980; 61:302. Graphic 61522 Version 3.0 危險(xiǎn)評估危險(xiǎn)評估決定治療決定治療 確定目標(biāo)值確定目標(biāo)值 達(dá)標(biāo)達(dá)標(biāo) 減少飽和脂肪酸和膽固醇的攝入減少飽和脂肪酸和膽固醇的攝入 選擇能夠促進(jìn)選擇能夠促進(jìn)LDL-C減少的食物（如植物甾醇、可溶性纖維）減少的食物（如植物甾醇、可溶性纖維） 減輕體重減輕體重 增加有規(guī)律的體力活動(dòng)增加有規(guī)律的體力活動(dòng) 針對其他心血管

9、病危險(xiǎn)因素的措施如戒煙、降低血壓等針對其他心血管病危險(xiǎn)因素的措施如戒煙、降低血壓等 要素要素 建議建議 使使LDL-C增加的營養(yǎng)素增加的營養(yǎng)素 飽和脂肪酸飽和脂肪酸* 總熱量的總熱量的7% 膳食膽固醇膳食膽固醇 10% 50% I/A 高危單個(gè)危險(xiǎn)因素顯著升高、 5%SCORE10% 2.5mmol/L (100 mg/dL) Iia/A 中危1%SCORE5%3.0mmol/L (115 mg/dL) Iia/C 臨床疾患和臨床疾患和(或或)危險(xiǎn)因素危險(xiǎn)因素 目標(biāo)目標(biāo)LDL-C水平水平 ASCVD1.8 mmol/L 糖尿病+高血壓或其他危險(xiǎn)因素*1.8 mmol/L 糖尿病 2.6 mmo

10、l/L 高血壓+1項(xiàng)其他危險(xiǎn)因素* 2.6 mmol/L 高血壓或3項(xiàng)其他危險(xiǎn)因素*3.4 mmol/L TC=total cholesterol; CHD=coronary heart disease. Martin MJ et al. Lancet. 1986;2:933-936; Castelli WP. Am J Med. 1984;76:4-12. TC (mg/dL) 6-year CHD incidence per 1000 men 295 0 25 50 75 100 125 150 Age-adjusted 6-year CHD mortality per 1000 men TC (mg/dL) 0 2 4 6 8 10 12 1