Article, see p 1878

Abundant observational evidence has shown the association between elevated low-density lipoprotein cholesterol (LDL-C) levels and adverse cardiovascular outcomes and premature cardiovascular death.^1,2 Extensive and highly consistent clinical trial evidence has also shown the benefits of lowering LDL-C with statin therapy in reducing cardiovascular risk.^3–8 For these reasons, the 2013 American College of Cardiology/American Heart Association cholesterol guidelines recommended statin therapy in these 4 statin benefit groups⁸:

Clinical atherosclerotic cardiovascular disease (ASCVD)

LDL-C ≥190 mg/dL, ≥21 years of age

Primary prevention—diabetes mellitus: 40–75 years of age, LDL-C 70–189 mg/dL

Primary prevention—no diabetes mellitus (7.5%), 10-year ASCVD risk, 40–75 years of age, LDL-C 70–189 mg/dL

Although overwhelming clinical trial evidence supports statin benefit groups 1,^3–5 3,^7,8 and 4,^6,8 until now there has not been direct randomized clinical trial evidence for improved outcomes in statin benefit group 2. The 2013 American College of Cardiology/American Heart Association cholesterol guidelines writing committee recognized that individuals ≥21 years of age with primary, severe elevations of LDL-C (≥190 mg/dL) have a high lifetime risk for ASCVD events. Therefore, the committee recommended statin treatment irrespective of calculated 10-year ASCVD risk in this high-risk cohort. Despite the evidence …

文章，请参阅第1878页

大量的观察证据表明，低密度脂蛋白胆固醇（LDL-C）水平升高与不良心血管结果和心血管过早死亡之间存在关联。^1，2广泛而高度一致的临床试验的证据还表明降低LDL-C与他汀类药物在降低心血管风险的好处。^{3 – 8}基于这些原因，2013年美国心脏病学会/美国心脏协会胆固醇指南建议在这4个他汀类药物受益人群中使用他汀类药物治疗⁸：

临床动脉粥样硬化性心血管疾病（ASCVD）

LDL-C≥190mg / dL，≥21岁

一级预防—糖尿病：40–75岁，LDL-C 70–189 mg / dL

一级预防-无糖尿病（7.5％），10年ASCVD风险，40–75岁，LDL-C 70–189 mg / dL

虽然压倒性的临床试验证据支持他汀类药物益处组1，^{3 - 5} 3 ^7，8和图4，^6，8，直到在他汀类药物益处组2的2013美国学院改善结果现在还没有直接的随机临床试验证据心脏病学/美国心脏协会胆固醇指南编写委员会认识到，年龄≥21岁且原发性LDL-C严重升高（≥190mg / dL）的个体终生罹患ASCVD事件的风险很高。因此，该委员会建议他汀类药物治疗，无论在该高危人群中如何计算10年ASCVD风险。尽管有证据……