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PCSK9抑制剂使用指南

已有 4785 次阅读 2017-5-26 07:45 |个人分类:临床指南和病例解析|系统分类:观点评述| style

PCSK9抑制剂使用指南

PCSK9抑制剂使用指南

ASCVD
1. PCSK9 inhibitor therapy should be considered for ASCVD risk reduction in patients with stable atherosclerotic cardiovascular disease,particularly in those with additional ASCVD risk factors, on maximally-tolerated statin therapy 6 ezetimibe, with on-treatment LDL-C>70 mg/dL or non–HDL-C>100 mg/dL. Strength A, Quality: High

2. PCSK9 inhibitor therapy may be considered to further reduce LDL-C in patients with progressive atherosclerotic cardiovascular
disease on maximally-tolerated statin therapy 6 ezetimibe, and on-treatment LDL-C>70 mg/dL or non–HDL-C>100 mg/dL. Strength B, Quality: Moderate

Phenotypic FH/LDL-C>190 mg/dL
3a PCSK9 inhibitor therapy may be considered to further reduce LDL-C in patients ages 40 to 79 years with phenotypic FH, pretreatment LDL-C>190 mg/dL, no uncontrolled ASCVD risk factors, or other key additional high-risk markers*, and on-treatment LDL-C>100 mg/dL or non–HDL-C>130 mg/dL on maximally-tolerated statin therapy 6 ezetimibe. Strength B, Quality: Moderate

3b PCSK9 inhibitor therapy may be considered to further reduce LDL-C in patients aged 40 to 79 years with phenotypic FH, pretreatment LDL-C $190 mg/dL, and the presence of either uncontrolled ASCVD risk factors, key additional high-risk markers*, or genetic confirmation of FH, and on-treatment LDL-C $70 mg/dL or non–HDL-C>100 mg/dL on maximally-tolerated statin 6 ezetimibe. Strength: B, Quality: Moderate

3c PCSK9 inhibitor therapy may be considered to further reduce LDL-C in patients aged 18 to 39 years with phenotypic FH, pretreatment LDL-C>190 mg/dL, and the presence of either uncontrolled ASCVD risk factors, key additional high-risk markers*, or genetic confirmation of FH, and on-treatment LDL-C>100 mg/dL or non–HDL-C>130 mg/dL on maximally-tolerated statin 6 ezetimibe. Strength: E, Quality: Low

3d PCSK9 inhibitor therapy may be considered to further reduce LDL-C in patients with homozygous familial hypercholesterolemia,
either of unknown genotype, or those known to be LDL receptor defective, on maximally-tolerated statin therapy 6 ezetimibe with LDL-C>70 mg/dL or non–HDL-C>100 mg/dL. Strength B, Quality: Moderate

Very-high-risk/statin intolerance
4. PCSK9 inhibitor therapy may be considered to further reduce LDL-C in selected very-high-risk patients who meet the definition of statin intolerance (as previously defined by the NLA Statin Expert Panel) and who require substantial additional atherogenic
cholesterol lowering, despite the use of other lipid-lowering therapies. Strength C, Quality: Low