二診斷評估與治療流程 1. 基本檢查 A. History taking (Especially family history), physical exams B. Check lipid profile (Total cholesterol, LDL-C, HDL-C, Triglyceri

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1 一血脂異常之分類與定義中華民國血脂異常分類之建議美國國家膽固醇教育計畫血脂小組血脂肪異常分級歐洲動脈硬化學會對血脂異常之治療性分類

2 二診斷評估與治療流程 1. 基本檢查 A. History taking (Especially family history), physical exams B. Check lipid profile (Total cholesterol, LDL-C, HDL-C, Triglyceride) 2. 排除造成高血脂的次發性原因 A. DM B. Hypothyroidism C. Obstructive liver disease D. Chronic renal failure E. Drugs: Increase LDL-C (Retinoid, Cyclosporine, Thiazide) Decrease HDL-C(Progesterone, Androgen, β-blocker, steroid) 3. 風險分類與擬定治療計畫與目標 ( 各學會治療指引 ) A. National Cholesterol Education Program ATP III Patient characteristics Risk category Updated LDL-C target Established CVD plus multiple major risk factors (especially diabetes), severe and persistent risk factors (especially smoking), multiple risk factors of metabolic syndrome, or acute coronary syndrome Very high * <70 mg/dl (1.81 mmol/l) CHD, or CHD risk equivalents, or Framingham 10 year risk >20% <100 mg/dl (2.59 mmol/l) 2+ risk factors with Framingham 10 year risk between 10% and 20% Moderately high <130 mg/dl (3.36 mmol/l) 2+ risk factors with Framingham 10 year risk <10% Moderate 0-1 risk factor Lower <130 mg/dl (3.36 mmol/l) <160 mg/dl (4.14 mmol/l) CHD risk equivalents (DM, PAD, Abdominal aortic aneurysm) Major risk factors Cigarette smoking Hypertension (BP 140/90 mmhg or on anti-hypertensive medication) Family history of premature CHD (CHD in first relative, male < 55 years old, female < 65 years old) Age (Male 45 years old; Female 55 years old or menopause woman with HRT)

3 B. European Guideline (ESC and EAS) Patient group Very high CV risk Established CVD, type 2 diabetes, type 1 diabetes with target organ damage, moderate-to-severe CKD or a SCORE level of 10% CV risk Markedly elevated single risk factors, a SCORE level of 5% to <10% Moderate CV risk SCORE* level >1% to 5% LDL-C treatment goal <1.8 mmol/l (<70 mg/dl) and/or 50% reduction when target level cannot be reached <2.5 mmol/l (~<100 mg/dl) <3.0 mmol/l (~<115 mg/dl) *SCORE = Systematic Coronary Risk Estimation C. American Heart Association Guideline Patient group ( 可因降血脂治療獲益的四大族群 ) 1. Patients who have CVD (clinical ASCVD*); 2. Patients with an LDL level of 190 mg/dl or higher; 3. Patients with Type 2 diabetes who are between 40 and 75 years of age (LDL-C 70 to189 mg/dl) 4. Patients with an estimated 10-year risk of CVD of 7.5 percent or higher who are between 40 and 75 years of age (the report provides formulas for calculating 10-year risk). LDL-C treatment goal 建議使用 Moderate to high intensity statin D American Diabetes Association Standard of Care Position Statement Recommendation for statin and combination treatment in people with diabetes Age Risk factors Recommended statin intensity* <40 years None ASCVD risk factor(s)** None Moderate or high years None ASCVD risk factors ACS and LDL-C >50 mg/dl in Moderate Moderate plus ezetimibe patients who cannot tolerate high-dose statins >75 years None ASCVD risk factors ACS and LDL-C >50 mg/dl in patients who cannot tolerate high-dose statins Moderate Moderate or high Moderate plus ezetimibe ** LDL cholesterol 100 mg/dl (2.6 mmol/l), high blood pressure, smoking, and overweight and obesity

4 三高血脂的非藥物治療所有高血脂的治療都應先從非藥物治療做起, 包括減重維持每周 150 分鐘以上中等程度的運動減少飽和脂肪酸攝取戒菸戒酒等四高血脂的藥物治療 1. 各種 Statin 降血脂強度 Typical LDL-C Reductions (% Change from Baseline) by Statin Dose Treatment 5 mg 10 mg 20 mg 40 mg 80 mg Rosuvastatin Atorvastatin Simvastatin Lovastatin Pravastatin Fluvastatin Pitavastatin (1mg)-32 (2mg)-36 (4mg)-43 Ezetimibe 10 mg plus variable simvastatin 高強度與中等強度 Statin 總覽 -intensity and moderate-intensity statin therapy -intensity statin therapy Moderate- intensity statin therapy Lowers LDL cholesterol by >50% Atorvastatin mg Rosuvastatin mg Lowers LDL cholesterol by 30% to <50% Atorvastatin mg Rosuvastatin 5-10 mg Simvastatin mg Pravastatin mg Lovastatin 40 mg Fluvastatin XL 80 mg Pitavastatin 2-4 mg 3. 其他種類藥物對於降血脂療效 ( 每日劑量不等於建議劑量 )

5 4. 全民健保降血脂藥物給付規定

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二 診斷 評估與治療流程 1. 基本檢查 A. History taking (Especially family history), physical exams B. Check lipid profile (Total cholesterol, LDL-C, HDL-C, Triglyceri

二診斷評估與治療流程 1. 基本檢查 A. History taking (Especially family history), physical exams B. Check lipid profile (Total cholesterol, LDL-C, HDL-C, Triglyceri