高胆固醇血症

最后审阅: 26 四月 2022
最后更新: 29 四月 2021

小结

定义

病史和体格检查

关键诊断因素

  • 存在的危险因素
  • 一级亲属早发型冠心病或血脂异常的家族史
  • 心血管疾病史
  • 饱和脂肪和反式脂肪酸的摄入量
  • 超重(尤其是腹型肥胖)
  • 黄斑瘤
  • 腱性黄色瘤
更多 关键诊断因素

其他诊断因素

  • 45 岁前发生角膜弓
  • 结节性黄色瘤
其他诊断因素

危险因素

  • 胰岛素抵抗和2型糖尿病
  • 超重(体重指数>25 kg/m²)
  • 吸烟
  • 甲状腺功能减退
  • 胆汁淤积性肝病
  • 肾病综合征
  • 与用药的关系
更多 危险因素

诊断性检查

首要检查

  • 血脂检查
  • 血清促甲状腺激素 (TSH)
  • 脂蛋白(a)
更多 首要检查

需考虑的检查

  • 基因检测
更多 需考虑的检查

治疗流程

急症处理

临床 ASCVD 患者:极高风险

有临床 ASCVD:非极高风险且≤75 岁

临床 ASCVD 患者:并非极高风险且>75 岁

无临床 ASCVD:LDL-C≥4.9 mmol/L(≥190 mg/dL)且无糖尿病(20-75 岁)

无临床 ASCVD 的患者:LDL-C≥4.1 mmol/L(≥160 mg/dL)且无糖尿病(20-39 岁)

无临床 ASCVD:LDL-C 1.8-4.9 mmol/L(70-189 mg/dL)且无糖尿病(40-75 岁)

无临床 ASCVD:LDL-C 1.8-4.9 mmol/L (70-189 mg/dL)且无糖尿病(>75 岁)

无临床 ASCVD:有糖尿病和风险增强因素(20-39 岁)

无临床 ASCVD:有糖尿病且无其他风险因素(40-75 岁)

无临床 ASCVD:有糖尿病和多种风险因素(40-75 岁)

无临床 ASCVD:有糖尿病(>75 岁)

持续性治疗

重度家族性高胆固醇血症

撰稿人

作者

Seth S. Martin, MD, MHS
Seth S. Martin

Associate Professor of Medicine/Cardiology

Director

Lipid Clinic

Ciccarone Center for the Prevention of Cardiovascular Disease

Division of Cardiology, Department of Medicine

Johns Hopkins University School of Medicine

Baltimore

MD

利益声明

SSM has received honoraria from the American College of Cardiology for educational activities. SSM is listed as a co-inventor on a pending patent filed by Johns Hopkins University for a novel method of LDL-cholesterol estimation. SSM received a charitable gift for the VLDL big data project from the David and June Trone Family Foundation, and has also received research support from the PJ Schafer Cardiovascular Research Fund, American Heart Association, Aetna Foundation, iHealth, Stanford MedX/Nokia, Google, and Apple. SSM has acted as a consultant for Abbott Nutrition, Pressed Juicery, Quest Diagnostics, Sanofi/Regeneron, Amgen, Novo Nordisk, Esperian, Akcea, and the Pew Institute.

Rhanderson Cardoso, MD
Rhanderson Cardoso

Cardiovascular Fellow

Pollin Prevention Fellow

Ciccarone Center for the Prevention of Cardiovascular Disease

Division of Cardiology, Department of Medicine

Johns Hopkins University School of Medicine

Baltimore

MD

利益声明

RC declares that he has no competing interests.

鸣谢

Dr Seth S. Martin and Dr Rhanderson Cardoso would like to gratefully acknowledge Dr Raul D. Santos, Dr Martin Engelhardt and Dr Michael Miller, the previous contributors to this topic.

利益声明

RDS has received honoraria for consulting, speaker activities and research from Astra Zeneca, Amgen, Akcea, Biolab, Esperion, Kowa, Pfizer, Merck, Novo-Nordisk, and Sanofi/Regeneron. ME declares that he has no competing interests. MM has received research grant support and honoraria for lectures from AstraZeneca, Merck-Schering Plough, and Pfizer. MM has received consulting fees from Pfizer, Merck-Schering Plough, and Roche.

同行评议者

Mahi Lakshmi Ashwath, MD

Assistant Professor of Medicine

Noninvasive Cardiology

MetroHealth Campus

Case Western Reserve University

Cleveland

OH

利益声明

MLA declares that he has no competing interests.

Deepak Bhatnagar, TD MBBS PhD FRCP FRCPI FRCPath

Consultant/Senior Lecturer in Diabetes & Metabolism

The Royal Oldham Hospital & University of Manchester Cardiovascular Research Group Diabetes Centre

Royal Oldham Hospital

Oldham

UK

利益声明

DB declares that he has no competing interests.

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