2018AHAGuidelineontheManagementofBloodCholesterolChenP2018-11-28Content•Review•HighBloodCholesterolandASCVD•TherapeuticModalities•PatientManagementGroupstriacylglycerol，TAGgastrointestinaltract,GIT•Review•HighBloodCholesterolandASCVD•TherapeuticModalities•PatientManagementGroupsContentCholesterol,Lipoproteins,andApolipoproteinB•Serumcholesterolanditslipoproteincarriers(LDL,VLDL,andHDL)areknowntoberelatedtoASCVD(arterioscleroticcardiovasculardisease).•LDL-Cisthedominantformofatherogeniccholesterol.•VLDListhechiefcarrieroftriglycerides,andVLDLcholesterol(VLDL-C)isalsoatherogenic.•Chylomicrons(CM)transportdietaryfat•non–HDL-C(LDL-C+VLDL-C)ismoreatherogenicthaneitherlipoproteinalone.•ThemainproteinembeddedinLDLandVLDLisapolipoproteinB(apoB),andapoBisastrongerindicatorofatherogenicitythanLDL-Calone•AlthoughLDL-Cisaprimarycauseofatherosclerosis,otherriskfactorscontribute,aswell.•Themajorriskfactorsincludecigarettesmoking,hypertension,dysglycemia,andotherlipoproteinabnormalities.•Atherosclerosisprogresseswithadvancingage,aperson’sagealsocountsasariskfactor.•Review•HighBloodCholesterolandASCVD•TherapeuticModalities•PatientManagementGroupsContentDietComposition,WeightControl,andPhysicalActivity•Vegetables,fruits,wholegrains,legumes,healthyproteinsources(low-fatdairyproducts,low-fatpoultry(withouttheskin),fish/seafood,andnuts),andnontropicalvegetableoils•Sweets,sugar-sweetenedbeverages,andredmeats（×）•Appropriatecalorierequirements,personalandculturalfoodpreferences,andnutritionaltherapyforothermedicalconditionsincludingdiabetes.•Caloricintakeshouldbeadjustedtoavoidweightgain,orinoverweight/obesepatients,topromoteweightloss.•Ingeneral,adultsshouldbeadvisedtoengageinaerobicphysicalactivity3-4sessionsperweek,lastingonaverage40minutespersessionandinvolvingmoderate-tovigorous-intensityphysicalactivity.Lipid-LoweringDrugs•Amonglipid-loweringdrugs,statinsarethecornerstoneoftherapy,inadditiontohealthylifestyleinterventions.•OtherLDL-loweringdrugsincludeezetimibe,bileacidsequestrants,andPCSK9inhibitors.•Triglyceride-loweringdrugsarefibratesandniacin;theyhaveamildLDL-loweringaction,butRCTsdonotsupporttheiruseasadd-ondrugstostatintherapyStatinTherapyNonstatinTherapies•Ezetimibeisthemostcommonlyusednonstatinagent.ItlowersLDL-Clevelsby13%to20%andhasalowincidenceofsideeffects•BileacidsequestrantsreduceLDL-Clevelsby15%to30%dependingonthedose.•PCSK9inhibitorsarepowerfulLDL-loweringdrugs.Theygenerallyarewelltolerated,butlong-termsafetyremainstobeprovenNonstatinAdd-onDrugstoStatinTherapy•TheadditionofabileacidsequestrantorezetimibetoastatinregimenincreasesthemagnitudeofLDL-Cloweringbyapproximately15%to30%and13%to20%,respectively•TheadditionofaPCSK9inhibitortoastatinregimenhasbeenshowntofurtherreduceLDL-Clevelsby43%to64%•Review•HighBloodCholesterolandASCVD•TherapeuticModalities•PatientManagementGroupsContentSecondaryASCVDPreventionPrimaryPreventionTHANKS
