成人血脂异常管理路径：AACE共识声明 2025更新

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成人血脂异常管理路径：AACE共识声明 2025更新

制定者：

美国临床内分泌医师学会(AACE,American Association of Clinical Endocrinologists)

2025年9月13日

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摘要:

中英对照

Objective

To provide visual guidance in concise algorithms and tables to assist with clinical decision making in the management of adults with dyslipidemia to reduce risk of ASCVD and triglyceride-induced pancreatitis.

Methods

An international multidisciplinary task force of clinical experts was convened to update the 2020 AACE algorithm for dyslipidemia. Literature searches informed the creation of visual guidance graphics and supporting narratives that reflect consensus of the task force.

Results

The 2025 algorithm for the management of adults with dyslipidemia includes the following sections: (1) guiding principles for patient-centered management of dyslipidemia; (2) risk assessment and testing for dyslipidemia; (3) identifying genetic dyslipidemias; (4) specific lifestyle recommendations for adults with dyslipidemia; (5) targeting LDL-cholesterol with pharmacologic therapy for ASCVD prevention in adults; (6) approach to statin-associated muscle symptoms in adults; (7) management of adults with hypertriglyceridemia; (8) management of special populations with dyslipidemia (older adults, adults receiving transgender care or HIV control, adults with autoimmune disorders, survivors of childhood cancers, adults with organ transplantation); (9) management of hypercholesterolemia in pregnant and lactating individuals; (10) management of hypertriglyceridemia in pregnant and lactating individuals; and (11) FDA-approved medications for dyslipidemia.

Conclusions

This 2025 dyslipidemia algorithm update aligns with the 2025 AACE Clinical Practice Guideline for Pharmacologic Management of Adults with Dyslipidemia and other recent AACE guidance. The algorithm is also in agreement with guidance provided by the other international bodies represented within this task force. This update emphasizes ASCVD risk assessment, addresses pancreatitis risk, and highlights individualized pharmacotherapy. The algorithm includes considerations on health equity, cost effectiveness, and the benefits and harms of different management options.

目的

通过简洁的算法流程图和表格提供可视化指导，协助临床决策以管理成人血脂异常，降低动脉粥样硬化性心血管疾病（ASCVD）及甘油三酯诱发胰腺炎的风险。

方法

召集国际多学科临床专家工作组，对2020年AACE血脂异常管理路径进行更新。通过文献检索制定可视化指导图表及获得工作组共识的支持性说明。

结果

2025版成人血脂异常管理路径包含以下章节：(1) 以患者为中心的血脂异常管理指导原则；(2) 血脂异常的风险评估与检测；(3) 遗传性血脂异常的识别；(4) 成人血脂异常患者特异性生活方式建议；(5) 通过药物治疗降低LDL-C以预防成人ASCVD；(6) 成人他汀相关肌肉症状的处理方法；(7) 高甘油三酯血症成人患者管理；(8) 特殊人群血脂异常管理（老年人、接受跨性别护理或HIV控制者、自身免疫性疾病患者、儿童癌症幸存者、器官移植受者）；(9) 妊娠期及哺乳期高胆固醇血症管理；(10) 妊娠期及哺乳期高甘油三酯血症管理；(11) FDA批准的血脂异常治疗药物。

结论

本2025版路径更新与《2025年AACE成人血脂异常药物治疗临床实践指南》及AACE最新指导文件保持一致，并与工作组成员所属国际机构的指导建议相契合。本次更新强调ASCVD风险评估，关注胰腺炎风险，突出个体化药物治疗方案，同时涵盖健康公平性、成本效益及不同管理方案获益与风险的考量。