他汀(statin) 類藥物一直是血脂異常患者和預防動脈粥樣硬化性心血管疾病(ASCVD) 的 主要治療方法。針對預防ASCVD的statin 治療，2013 年美國心臟病學會/ 美國心臟協會(ACC / AHA) 的血脂治療準則提出了四大受益族群，包括：已有臨床ASCVD病人，低密度膽固醇 (LDL-C) ≥ 190 mg/dL，糖尿病，以及預測10 年ASCVD風險 ≥ 7.5% 者。此外，2013 年ACC / AHA血脂治療準則也建議使用不同的statin 劑量強度來治療不同風險類別的病人，但卻沒有 提出建議的LDL-C治療目標。2016年歐洲心臟學會(ESC) 和歐洲動脈粥樣硬化協會(EAS) 的 血脂治療準則提出了SCORE風險評估系統。對於非常高風險(very high-risk)，高風險(highrisk) 和中度風險(moderate-risk) 的患者，LDL-C的治療目標分別為 <70 mg/dL，<100 mg/dL和 <115 mg/dL。而2017年台灣血脂治療準則明確界定了高危病人和LDL-C的治療目標。對於周 邊動脈疾病(PAD)，腦血管疾病，DM和家族性高膽固醇血症(FH) 患者，建議LDL-C須<100 mg/dL，而急性冠心症(ACS) 或穩定性冠狀動脈疾病(CAD) 病人則建議LDL-C須<70 mg/dL。 對於ACS 且合併DM之病人，LDL-C應 <55 mg/dL。目前已有幾種新型藥物用於FH的輔助治 療，與statin 類藥物併用，進一步降低血液中的LDL-C。Mipomeren 是載脂蛋白(Apo B) 的反 寡核苷酸(ASO) 抑製劑。Lomitapide 可抑制微粒體甘油三酯轉運蛋白(MTP)。Evolocumab， alirocumab 和bococizumab 是前蛋白轉化酶枯草桿菌蛋白酶/ kexin 9 型(PCSK9) 抑製劑。上述 新型藥物是否可以預防臨床不良心血管事件仍待進一步的研究。

Statins have been the main treatment for patients with dyslipidemia and for prevention of clinical atherosclerotic cardiovascular disease (ASCVD). According to the 2013 American College of Cardiology / American Heart Association (ACC/AHA) lipid guideline, four statin benefit groups were issued, including patients with clinical ASCVD, low-density lipoprotein cholesterol (LDL-C) >190 mg/dL, diabetes mellitus (DM), or with 10-year ASCVD risk of >7.5%. Although the ACC/AHA guideline suggested the intensity of statin treatment for patients with different risk categories, it did not recommend the specific target levels of LDL-C. The 2016 European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) guideline suggested the SCORE system for risk assessment. For very high-risk, high-risk, and moderate-risk patients, the treatment goals of LDL-C were <70 mg/dL, <100 mg/dL, and <115 mg/dL, respectively. The 2017 Taiwan lipid guidelines clearly defined the high-risk patients and the treatment goals of LDL-C. For patients with peripheral arterial disease (PAD), cerebrovascular disease, DM, and familial hypercholesterolemia (FH), the LDL-C <100 mg/dL is suggested, whereas LDL-C <70 mg/dL is suggested for patients with acute coronary syndrome (ACS) or stable coronary artery disease (CAD). For diabetic patients with ACS, LDL-C should be <55 mg/ dL. Several novel agents have become available as adjunctive treatment of FH to reduce LDL-C levels. For example, mipomersen is an antisense oligonucleotide (ASO) inhibitor of apolipoprotein B (Apo B). Lomitapide can inhibit the microsomal triglyceride transfer protein (MTP). Evolocumab, alirocumab, and bococizumab are proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. Further studies are necessary to confirm the effects of these aforementioned agents on clinical outcomes. (J Intern Med Taiwan 2017; 28: 223-231)