New guidelines: Cholesterol should be on everyone's radar, beginning early in life
By Lucy Soto, 美国心脏协会 沙巴足球体育平台
终生暴露在高胆固醇环境中会增加患心脏病或中风的风险, and new scientific guidelines say managing this waxy, fat-like substance in the blood should be a concern for all ages.
The guidelines, published Saturday in the journal 循环，旨在帮助医疗保健提供者预防、诊断和治疗高胆固醇. 来自美国心脏协会和其他11个健康组织的24名科学和健康专家组成的小组为患有非常特殊疾病和风险的人撰写了基于科学的建议.
证据是压倒性的. Scott M. 心胸狭窄的人, 指南编写委员会主席，达拉斯德克萨斯大学西南医学中心内科教授. "Essentially no one says cholesterol is not important. The whole world now understands – it's important."
Nearly one of every three American adults have high levels of LDL, 所谓的“坏”胆固醇会导致脂肪堆积和动脉狭窄, 称为动脉粥样硬化. 全球和U.S. 研究表明，健康人群的最佳水平是低于100毫克/分升(毫克/分升), 研究试验表明，心脏病风险增加的人在服用降低低密度脂蛋白升高水平的药物后，患心脏病和中风的可能性降低.
“低密度脂蛋白胆固醇颗粒确实是这种疾病生物学中的核心分子,”医生说。. 唐纳德-琼斯, 他是芝加哥西北大学预防医学系的写作委员会成员和系主任. “重要的是要了解暴露的生命过程以及发生这种情况的其他风险因素的背景."
Along with well-established risk factors such as smoking, 高血压和高血糖, 该指南还建议关注“风险增加因素”，如家族史和其他健康状况，以更好地了解一个人在未来10年的整体风险.
该指南建议医生使用计算器对一个人10年内患心脏病的风险进行详细评估，并帮助制定个性化的计划. For most patients who can't control the condition with diet and exercise, a cholesterol-reducing drug called a statin can be used. 对于高危患者, including those who already have coronary heart disease, stroke or very high cholesterol caused by genetic conditions, additional drugs called ezetimibe and PCSK9 inhibitors can be used.
"The truth about clinical medicine is there is no black and white. It's all gray," said Lloyd-Jones, a practicing cardiologist. “这就是为什么本文件的重点是确保患者和医生就药物治疗的益处和潜在风险进行充分的讨论. 如果病人有心脏病发作或中风，我们知道这些人会从他汀类药物中受益. When there is someone who hasn't had an event, 这时做决定就比较困难了，详细和个性化的讨论非常重要."
For people 40 to 75 years old without evident heart disease, the guidelines use four classifications of risk: low, 边缘, 中级和高级.
当病人处于中间地带时, 有时在边缘, 该指南建议医生与患者深入讨论他汀类药物的潜在益处, 考虑到所有的风险因素. If uncertainty remains about whether to use a statin, doctors can consider delving further with a test called a coronary artery calcium, 或CAC, 筛选. CAC评分是通过对心脏进行CT扫描，并确定心脏动脉中积累了多少钙斑块来计算的.
适合20到39岁的年轻人, 该指南强调健康的生活方式, maintaining a healthy diet and weight and exercising regularly, 心胸狭窄的人说.
Because of a lack of long-term research for this younger age group, statin recommendations are reserved for those at higher risk.
But 心胸狭窄的人说 that doesn't mean those patients should be ignored, 因为具有高胆固醇等危险因素的年轻人通常已经出现了动脉粥样硬化的初期阶段.
"We think doctors ought to pay more attention to young adults,格伦迪说。, 他也是达拉斯退伍军人医疗中心代谢科的主任. “如果他们的胆固醇高, they should try their best through the right kind of diet, 保持体重. … They might not need a statin, but they certainly need attention."
因为终生接触高胆固醇会有潜在的危险, 尤其是低密度脂蛋白, 该指南建议医生考虑对有早期心脏病或高胆固醇家族史的2岁以下儿童进行选择性筛查. 在没有任何已知危险因素的儿童中, 医生可能会建议在9岁到11岁之间进行检查，然后在17岁到21岁之间再次进行检查.
“这抓住了那些患有严重胆固醇疾病的人，他们需要通过改变生活方式进行早期治疗, 很少, 适合10岁以上的人, 药物治疗,”医生说。. 莎拉·D. Ferranti德, 他是哈佛医学院波士顿儿童医院门诊心脏病学主任和预防心脏病学主任. “这很重要, 即使在很小的时候, 人们正在遵循一种对心脏有益的生活方式，了解并保持健康的胆固醇水平."
It's a "lifespan approach" to thinking about cholesterol, 德费兰蒂说, who was also on the guideline writing committee.
作为一名儿科医生, 这是很自然的，因为我们的目标一直是让我们的病人在成年后有最好的机会过上健康长寿的生活,她说. 20岁时心脏健康状况正常的人更有可能活到心血管健康因素正常的50岁.
It's a reality that Carl Korfmacher of Wisconsin experienced just before turning 10, when he watched his 37-year-old father die of a heart attack. 在那之前, 他的父亲, 谁也是吸烟者, had learned he had hardening of the arteries caused by high cholesterol.
Afterward, Korfmacher and his siblings had their cholesterol checked. He embarked on a lifetime of monitoring his diet, 锻炼和, 晚些时候, 服用高胆固醇药物.
Six years ago, when his own sons were 12 and 8, they were tested, too. 他们的胆固醇水平也很高，医生让他们服用小剂量的他汀类药物. 今天，他们经营得很好.
"There's no reason not to check it," said Korfmacher, 55. “这是一个风险因素. Just because you have high cholesterol doesn't mean you are going to die like my dad, but you should get plenty of exercise and not smoke. If you are overweight and staring at a screen, those things are just as important."
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