Your cholesterol levels can affect your risk of heart disease and stroke. And the longer you have high cholesterol, the greater your risk.

胆固醇水平会影响罹患心脏病和中风的风险。胆固醇水平偏高持续的时间越长，患病风险就越高。

That’s why leading medical groups recommend getting your cholesterol checked regularly, and working to lower your levels even when they’re only slightly elevated, in some cases. Last month, the American College of Cardiology and other medical organizations released new guidelines to help patients and doctors know what cholesterol levels to aim for, and which medications might help.

正因为如此，主流医学团体建议定期检测胆固醇水平，在某些情况下，胆固醇水平即使只是轻度升高，也要着手开始降低。上个月，美国心脏病学会联合多家医学机构发布了新版指南，帮助患者和医生明确胆固醇的控制目标，以及适用的药物方案。

We asked doctors to break down the recommendations.

我们邀请医生对这份指南进行了详细解读。

To start, know your levels.

首先，了解自己的胆固醇水平

The guidelines recommend that adults, starting at age 19, have their cholesterol checked at least every five years. (Before that, children should have their cholesterol checked once, between ages 9 to 11, to screen for inherited high cholesterol.)

指南建议，19岁及以上的成年人至少每五年检测一次胆固醇。（在此之前，儿童应在9-11岁期间检测一次胆固醇，筛查遗传性高胆固醇。）

A lipid panel, which you can have done with a blood draw at your primary care doctor’s office, looks at several types of cholesterol. Of these, doctors focus most on low-density lipoprotein, or LDL, a “bad cholesterol” that can build up in your artery walls. We have “overwhelming evidence” that the lower your LDL levels, the lower your risk of a cardiovascular event like a heart attack or a stroke, said Dr. Erin D. Michos, associate director of preventive cardiology at Johns Hopkins University School of Medicine.

血脂检测只需在全科医生诊室抽血即可完成，会检测多种胆固醇指标。其中，医生最关注低密度脂蛋白(LDL)——也就是会在动脉壁沉积的“坏胆固醇”。约翰斯·霍普金斯大学医学院预防心脏病学副主任艾琳·米科斯表示，我们有“压倒性的证据“，表明低密度脂蛋白水平越低，心脏病发作、中风等心血管事件的风险就越低。”

The guidelines also recommend that all adults now have levels of Lipoprotein(a), a genetically determined form of cholesterol, tested at least once. Lp(a) increases the risk of heart disease, regardless of your other lipid levels. “It’s an amplifier of whatever your risk is,” said Dr. Ann Marie Navar, an associate professor of cardiology at the U.T. Southwestern Medical Center in Dallas. We reach our adult levels in childhood, and they remain relatively stable over a lifetime, with a few exceptions.

指南还新增要求：所有成年人至少检测一次脂蛋白(a)[Lp(a)]——这是一种由基因决定的胆固醇类型。无论其他血脂指标如何，脂蛋白(a)升高都会增加心脏病风险。达拉斯德克萨斯大学西南医学中心心脏病学副教授安·玛丽·纳瓦尔说：“它会放大你本身现有的任何风险。” 脂蛋白(a)水平在童年时期就达到成人水平，除少数例外情况，一生都相对稳定。

There’s another, less widely used test for a different lipoprotein called ApoB. This is perhaps the best measure of cholesterol related risk, Dr. Navar said, because it reflects the total number of “bad” cholesterol particles, including not just LDL, but also Lp(a) and another type called vLDL. This makes it a more reliable measure, especially for people with metabolic disease, including diabetes and cardiovascular-kidney-metabolic syndrome, because of differences in LDL particle size and density in these patients.

还有一种应用较少的检测，针对载脂蛋白B(ApoB)。纳瓦尔表示，这或许是评估胆固醇相关风险的最佳指标，因为它反映了所有“坏”胆固醇颗粒的总数，不仅包括低密度脂蛋白，还包括脂蛋白(a)和极低密度脂蛋白(vLDL)。因此这一指标更为可靠，尤其是对于糖尿病、心肾代谢综合征等代谢性疾病患者而言，因为这类患者的低密度脂蛋白颗粒大小和密度存在差异。

Determine your individual risk.

评估个人患病风险

It’s never too early to talk with your doctor about your risk of heart disease, and you should build heart-healthy habits like eating a Mediterranean-style or DASH diet and exercising regularly as soon as possible. But starting at age 30, the conversation can include an actual prediction of your future risk. The guidelines use a new calculator, called PREVENT, that includes risk factors that weren’t previously taken into account, including body mass index and kidney disease.

和医生讨论心脏病风险永远不嫌太早，而且你应该尽早养成有益心脏的生活习惯，比如坚持地中海饮食或得舒饮食、规律运动。但从30岁开始，这种讨论可以包含对未来风险的实际预测。指南采用了一款名为PREVENT的新型风险计算工具，纳入了此前未被考虑的危险因素，包括体重指数和肾脏疾病。

It assesses both short-term (10-year) and long-term (30-year) risk.

该工具可同时评估短期（10年）和长期（30年）患病风险。

Measuring long-term risk is particularly useful for people 30 to 59. Doctors might look at a younger patient who isn’t at risk of heart disease in the next 10 years, but could be in the long-term, and recommend that they start taking a statin.

长期风险评估对30-59岁人群尤为重要。有些年轻患者未来10年的心脏病风险较低，但长期风险较高，医生可能会建议他们提前开始服用他汀类药物。

“We want to reduce their lifetime exposure” to these bad cholesterol particles, Dr. Michos said. “The risk is not only how high a level is, it’s how many years one’s arteries are exposed to these high levels,” similar to how doctors look at “pack-years” of smoking.

“我们希望减少他们一生中接触这些坏胆固醇颗粒的时间，”米科斯说。“风险不仅取决于胆固醇水平有多高，还取决于动脉暴露在高胆固醇环境中的年数。”这和医生评估吸烟者的‘包年’（每天吸烟包数乘以吸烟年数——译注）是同一个道理。

People who are at low 10-year risk don’t typically need to start medication, unless they have an LDL level of 160 mg/dL or greater, or have a high 30-year risk.

10年风险较低的人群通常不需要用药，除非低密度脂蛋白水平≥160mg/dL，或30年风险较高。

For people who are at borderline or intermediate risk, a coronary arterial calcium (CAC) score — which uses a low-dose CT scan to look for evidence of plaque buildup in the heart arteries — can help with decision making. That evidence can be a powerful motivator for asymptomatic patients to take medication, said Dr. Martha Gulati, a professor of cardiology at Houston Methodist DeBakey Heart & Vascular Center.

对于临界风险或中等风险人群，冠状动脉钙化(CAC)评分（通过低剂量CT扫描检测心脏动脉内的斑块沉积情况）可以帮助医生做出决策。休斯顿卫理公会德贝基心脏与血管中心心脏病学教授玛莎·古拉蒂表示，检测结果能有效促使无症状患者接受药物治疗。

In considering treatment, doctors also take into account other factors that might raise a person’s risk of heart disease, such as South Asian race, diabetes, early menopause, pre-eclampsia or gestational diabetes, for example. They also consider inflammatory conditions like rheumatoid arthritis and psoriasis, since inflammation contributes to plaque buildup in the arteries.

在制定治疗方案时，医生还会考虑其他增加心脏病风险的因素，比如南亚裔、糖尿病、早绝经、先兆子痫或妊娠期糖尿病，以及类风湿性关节炎、银屑病等炎症性疾病,因为炎症会加速动脉斑块的形成。

Know your goal.

明确目标

The new guidelines give specific target levels of LDL based on short- and long-term risk of heart disease.

新版指南根据心脏病的短期和长期风险，给出了具体的低密度脂蛋白目标值：

•For general prevention of heart disease in people who are at borderline or intermediate 10-year risk and don’t have diabetes or heart disease, the goal is an LDL level under 100 mg/dL.

· 对于10年风险为临界或中等、且无糖尿病或心脏病的普通人群，其一般性预防目标为低密度脂蛋白＜100mg/dL

•For patients at high 10-year risk, people with longstanding Type 2 diabetes or complications of diabetes, or people with CAC scores over 100, the goal is under 70 mg/dL.

· 对于10年高风险人群、长期二型糖尿病患者或糖尿病并发症患者、以及冠状动脉钙化评分＞100分的人群，目标为低密度脂蛋白＜70mg/dL

•For most patients who have already had a heart attack or a stroke, the goal is under 55 mg/dL. This might seem like an especially aggressive goal. But “with very intensive cholesterol lowering, we can actually shrink plaque,” Dr. Michos said, reducing the risk of future cardiovascular issues.

·对于大多数已经发生过心脏病发作或中风的患者，目标为低密度脂蛋白＜55mg/dL。这个目标看起来尤为激进，但米科斯博士表示：“通过高强度降胆固醇治疗，我们实际上可以缩小斑块体积”，从而降低未来心血管事件的风险。

Work with your doctor to find the right medication plan.

和医生共同制定合适的用药方案

Most patients with continuously high cholesterol levels will need medication. Statins, which block the liver from making cholesterol, are still the first line of treatment. “They’re cheap,” Dr. Gulati said. “We’ve had them for over four decades. They reduce bad cardiovascular outcomes.”

大多数胆固醇持续升高的患者都需要药物治疗。他汀类药物通过抑制肝脏合成胆固醇发挥作用，目前仍是一线治疗方案。“这类药物价格低廉，”古拉蒂博士说。“我们使用它们已经有40多年，能有效减少不良心血管事件的发生。”

“They’re good drugs despite their bad P.R.,” she added, referring to common concerns about side effects. She noted that in randomized controlled trials, people who took a placebo experienced the same side effects as those who took statins.

“尽管公关形象不好，但它们其实是好药，”她还说，这里指的是人们对他汀类药物副作用的普遍担忧。她指出，在随机对照试验中，服用安慰剂的人群和服用他汀类药物的人群，报告的副作用发生率并无差异。

But there are also many other medications at doctors’ disposal, including ezetimibe, which inhibits the absorption of cholesterol from food; bempedoic acid, which blocks production of cholesterol in the liver; and a much newer class of drugs called PCSK9 inhibitors, which help the liver clear LDL from the blood. (The PCSK9 inhibitors are currently approved as injections, but trials for a pill form are also underway.)

不过医生还有很多其他药物可选，包括：抑制肠道吸收食物中胆固醇的依折麦布；能阻断肝脏胆固醇合成的贝派地酸；以及更新的药物PCSK9抑制剂，它能帮助肝脏清除血液中的低密度脂蛋白。（PCSK9抑制剂目前获批的剂型为注射剂，但口服剂型的临床试验也在进行中。）

“If you try a statin and can’t tolerate it, we have other medications,” Dr. Navar said. “If you try a statin but you’re not at goal, you may need more than one medication.”

“如果服用他汀类药物不耐受，我们还有其他选择，”纳瓦尔说。“如果服用他汀类药物后仍未达到目标，可能需要联合使用多种药物。”

“There are a lot of options out there,” she added.

“现在的治疗方案非常丰富，”她还说。