Lipid disorders involving derangements in serum cholesterol, triglycerides or both are commonly encountered in clinical practice and often have implications for cardiovascular risk and overall health. Recent advances in knowledge, recommendations and treatment options have necessitated an updated approach to these disorders. Older classification schemes have outlived their usefulness yielding to an approach based on the primary lipid disturbance identified on a routine lipid panel as a practical starting point. While monogenic dyslipidemias exist and are important to identify, most individuals with lipid disorders have polygenic predisposition, often in the context of secondary factors such as obesity and type 2 diabetes. With regard to cardiovascular disease, elevated low density lipoprotein cholesterol is essentially causal and clinical practice guidelines worldwide have recommended treatment thresholds and targets for this variable. Furthermore, recent studies have established elevated triglycerides as a cardiovascular risk factor, while depressed high density lipoprotein cholesterol now appears less contributory than was previously believed. An updated approach to diagnosis and risk assessment may include measurement of secondary lipid variables such as apolipoprotein B and Lipoprotein(a), together with selective use of genetic testing to diagnose rare monogenic dyslipidemias such as familial hypercholesterolemia or familial chylomicronemia syndrome. The ongoing development of new agents – especially antisense RNA and monoclonal antibodies - targeting dyslipidemias will provide additional management options, which in turn motivates discussion on how best to incorporate them into current treatment algorithms.

中文翻译：

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治疗血脂异常的现代方法

涉及血清胆固醇、甘油三酯或两者的紊乱的脂质紊乱在临床实践中经常遇到，并且通常对心血管风险和整体健康有影响。知识、建议和治疗方案的最新进展需要对这些疾病采取更新的方法。旧的分类方案已经过时了，它们的效用已经过时，只能采用基于常规脂质面板上确定的主要脂质紊乱作为实际起点的方法。虽然存在单基因血脂异常并且对其进行识别很重要，但大多数患有血脂异常的个体具有多基因易感性，通常在肥胖和 2 型糖尿病等次要因素的背景下。关于心血管疾病，升高的低密度脂蛋白胆固醇本质上是因果关系，世界范围内的临床实践指南已经推荐了该变量的治疗阈值和目标。此外，最近的研究已经确定甘油三酯升高是心血管危险因素，而现在降低的高密度脂蛋白胆固醇的作用似乎比以前认为的要小。更新的诊断和风险评估方法可能包括测量二级脂质变量，如载脂蛋白 B 和脂蛋白 (a)，以及选择性使用基因检测来诊断罕见的单基因血脂异常，如家族性高胆固醇血症或家族性乳糜微粒血症综合征。