老年高脂血症

1、 起因分类起因分类 表型分类表型分类 基因分类基因分类 n 家族性高胆固醇血症家族性高胆固醇血症 n 家族性载脂蛋白家族性载脂蛋白B缺陷症缺陷症 n 家族性混合型高脂血症家族性混合型高脂血症 n 家族性异常家族性异常脂蛋白血症脂蛋白血症 n 家族性高甘油三酯血症家族性高甘油三酯血症 n 多基因家族性高胆固醇血症多基因家族性高胆固醇血症 n 家族性脂蛋白家族性脂蛋白(a)过多血症过多血症 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 一千三百零一点一七亿元人民币一千三百零一点一七亿元人民币 不稳定不稳定 斑块斑块 破裂斑块破裂斑块 内膜增厚内膜增厚 动脉粥样化动脉粥样化 形成形成 正常动脉正常动脉内皮功能不全内

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新生儿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 危险评估危险评估决定治疗决定治疗 确定目标值确定目标值 达标达标 减少饱和脂肪酸和胆固醇的摄入减少饱和脂肪酸和胆固醇的摄入 选择能够促进选择能够促进LDL-C减少的食物（如植物甾醇、可溶性纤维）减少的食物（如植物甾醇、可溶性纤维） 减轻体重减轻体重 增加有规律的体力活动增加有规律的体力活动 针对其他心血管

9、病危险因素的措施如戒烟、降低血压等针对其他心血管病危险因素的措施如戒烟、降低血压等 要素要素 建议建议 使使LDL-C增加的营养素增加的营养素 饱和脂肪酸饱和脂肪酸* 总热量的总热量的7% 膳食胆固醇膳食胆固醇 10% 50% I/A 高危单个危险因素显著升高、 5%SCORE10% 2.5mmol/L (100 mg/dL) Iia/A 中危1%SCORE5%3.0mmol/L (115 mg/dL) Iia/C 临床疾患和临床疾患和(或或)危险因素危险因素 目标目标LDL-C水平水平 ASCVD1.8 mmol/L 糖尿病+高血压或其他危险因素*1.8 mmol/L 糖尿病 2.6 mmo

10、l/L 高血压+1项其他危险因素* 2.6 mmol/L 高血压或3项其他危险因素*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