{"id":137090,"date":"2025-09-06T15:04:05","date_gmt":"2025-09-06T08:04:05","guid":{"rendered":"https:\/\/vnras.com\/drug\/?p=137090"},"modified":"2025-09-09T16:31:44","modified_gmt":"2025-09-09T09:31:44","slug":"huong-dan-esc-2025-ve-quan-ly-roi-loan-lipid-mau-cap-nhat-dua-tren-huong-dan-esc-eas-2019","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/huong-dan-esc-2025-ve-quan-ly-roi-loan-lipid-mau-cap-nhat-dua-tren-huong-dan-esc-eas-2019\/","title":{"rendered":"H\u01b0\u1edbng d\u1eabn ESC 2025 v\u1ec1 qu\u1ea3n l\u00fd r\u1ed1i lo\u1ea1n lipid m\u00e1u: C\u1eadp nh\u1eadt d\u1ef1a tr\u00ean H\u01b0\u1edbng d\u1eabn ESC\/EAS 2019"},"content":{"rendered":"

Khoa N\u1ed9i tim m\u1ea1ch \u2013 Vi\u1ec7n tim m\u1ea1ch<\/p>\n

B\u1ec7nh vi\u1ec7n Trung \u01b0\u01a1ng Qu\u00e2n \u0111\u1ed9i 108<\/p>\n

T\u1ea3i PDF T\u1ea1i \u0111\u00e2y<\/a>.<\/p>\n

H\u01b0\u1edbng d\u1eabn ESC v\u1ec1 qu\u1ea3n l\u00fd r\u1ed1i lo\u1ea1n lipid m\u00e1u<\/h2>\n
The material was adapted from the \u20182025 Focused Update of the 2019 ESC\/EAS Guidelinesfor the management of dyslipidaemias\u2019 European Heart Journal; doi:10.1093\/eurheartj\/ehaf190; as published on 29 August 2025.<\/p>\n
\u0110\u1ed9i ng\u0169 t\u00e1c gi\u1ea3 v\u00e0 th\u00e0nh vi\u00ean Task Force<\/h3>\n
Ch\u1ee7 t\u1ecbch ESC: Fran\u00e7ois Mach, Konstantinos C. Koskinas (Th\u1ee5y S\u0129)<\/p>\n
Ch\u1ee7 t\u1ecbch EAS: Jeanine Roeters van Lennep (H\u00e0 Lan)<\/p>\n
\u0110i\u1ec1u ph\u1ed1i vi\u00ean Task Force: Lale Tokg\u00f6zo\u011flu (Th\u1ed5 Nh\u0129 K\u1ef3)<\/p>\n
C\u00e1c th\u00e0nh vi\u00ean qu\u1ed1c t\u1ebf \u0111\u1ebfn t\u1eeb c\u00e1c qu\u1ed1c gia nh\u01b0 T\u00e2y Ban Nha, V\u01b0\u01a1ng qu\u1ed1c Anh, \u0110an M\u1ea1ch, \u00c1o, \u00dd, B\u1ec9, Ireland, \u0110\u1ee9c, Hy L\u1ea1p, M\u1ef9.<\/p>\n
C\u00e1c t\u1ed5 ch\u1ee9c ESC tham gia ph\u00e1t tri\u1ec3n t\u00e0i li\u1ec7u<\/h3>\n
C\u00e1c Hi\u1ec7p h\u1ed9i<\/strong>: ACNAP, ACVC, EACVI, EAPC, EAPCI, EHRA, HFA.<\/p>\n
C\u00e1c h\u1ed9i \u0111\u1ed3ng<\/strong>: H\u1ed9i \u0111\u1ed3ng Th\u1ef1c h\u00e0nh Tim m\u1ea1ch, H\u1ed9i \u0111\u1ed3ng Khoa h\u1ecdc C\u01a1 b\u1ea3n Tim m\u1ea1ch.<\/p>\n
C\u00e1c nh\u00f3m chuy\u00ean m\u00f4n<\/strong>: Tim b\u1ea9m sinh ng\u01b0\u1eddi l\u1edbn, \u0110\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 m\u1ea1ch ngo\u1ea1i vi, X\u01a1 v\u1eefa v\u00e0 sinh h\u1ecdc m\u1ea1ch, D\u01b0\u1ee3c tim m\u1ea1ch, Ph\u1eabu thu\u1eadt tim, Sinh h\u1ecdc t\u1ebf b\u00e0o tim, Sinh l\u00fd h\u1ecdc m\u1ea1ch v\u00e0 vi m\u1ea1ch, Gi\u1ea3i ph\u1eabu b\u1ec7nh l\u00fd ph\u00e1t tri\u1ec3n, Thrombosis.<\/p>\n
Di\u1ec5n \u0111\u00e0n b\u1ec7nh nh\u00e2n<\/strong>.<\/p>\n
Ph\u00e2n lo\u1ea1i m\u1ee9c \u0111\u1ed9 khuy\u1ebfn c\u00e1o ESC<\/h2>\n\n\n\n\n\n\n\n\n
Lo\u1ea1i khuy\u1ebfn c\u00e1o<\/td>\n \u00dd ngh\u0129a<\/td>\n C\u00e1ch d\u00f9ng thu\u1eadt ng\u1eef<\/td>\n<\/tr>\n
Class I<\/td>\n B\u1eb1ng ch\u1ee9ng v\u00e0 \u0111\u1ed3ng thu\u1eadn \u0111i\u1ec1u tr\u1ecb c\u00f3 l\u1ee3i, hi\u1ec7u qu\u1ea3<\/td>\n “\u0110\u01b0\u1ee3c khuy\u1ebfn c\u00e1o” ho\u1eb7c “Ch\u1ec9 \u0111\u1ecbnh”<\/td>\n<\/tr>\n
Class II<\/td>\n B\u1eb1ng ch\u1ee9ng\/xem x\u00e9t \u0111i\u1ec3m kh\u00f4ng r\u00f5 r\u00e0ng, c\u00f3 s\u1ef1 tranh lu\u1eadn<\/td>\n <\/td>\n<\/tr>\n
Class IIa<\/td>\n Nghi\u00eang v\u1ec1 c\u00f3 l\u1ee3i, hi\u1ec7u qu\u1ea3<\/td>\n “N\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t”<\/td>\n<\/tr>\n
Class IIb<\/td>\n \u00cdt ch\u1eafc ch\u1eafn h\u01a1n, c\u1ea7n c\u00e2n nh\u1eafc<\/td>\n “C\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem x\u00e9t”<\/td>\n<\/tr>\n
Class III<\/td>\n Kh\u00f4ng c\u00f3 l\u1ee3i, c\u00f3 th\u1ec3 g\u00e2y h\u1ea1i<\/td>\n “Kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o”<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
M\u1ee9c \u0111\u1ed9 b\u1eb1ng ch\u1ee9ng<\/h2>\n\n\n\n\n\n\n
C\u1ea5p b\u1eb1ng ch\u1ee9ng<\/td>\n Ngu\u1ed3n d\u1eef li\u1ec7u<\/td>\n<\/tr>\n
A<\/td>\n D\u1eef li\u1ec7u t\u1eeb nhi\u1ec1u th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean ho\u1eb7c ph\u00e2n t\u00edch meta<\/td>\n<\/tr>\n
B<\/td>\n D\u1eef li\u1ec7u t\u1eeb 1 th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean ho\u1eb7c nghi\u00ean c\u1ee9u l\u1edbn kh\u00f4ng ng\u1eabu nhi\u00ean<\/td>\n<\/tr>\n
C<\/td>\n \u00dd ki\u1ebfn chuy\u00ean gia ho\u1eb7c c\u00e1c nghi\u00ean c\u1ee9u nh\u1ecf, h\u1ed3i c\u1ee9u, \u0111\u0103ng k\u00fd<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Ph\u00e2n lo\u1ea1i nguy c\u01a1 tim m\u1ea1ch (CV risk categories)<\/h2>\n\n\n\n\n\n\n
R\u1ea5t cao (Very high risk)<\/td>\n C\u00f3 m\u1ed9t trong c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m:<\/p>\n
\n
B\u1ec7nh tim m\u1ea1ch x\u01a1 v\u1eefa (ASCVD) \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn l\u00e2m s\u00e0ng ho\u1eb7c qua h\u00ecnh \u1ea3nh: H\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p (ACS) g\u1ed3m nh\u1ed3i m\u00e1u c\u01a1 tim ho\u1eb7c \u0111au th\u1eaft ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh; h\u1ed9i ch\u1ee9ng m\u1ea1ch v\u00e0nh m\u1ea1n t\u00ednh; t\u00e1i th\u00f4ng m\u1ea1ch (PCI, CABG); \u0111\u1ed9t qu\u1ef5; c\u01a1n thi\u1ebfu m\u00e1u n\u00e3o tho\u00e1ng qua (TIA); v\u00e0 b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean. ASCVD ch\u1eafc ch\u1eafn tr\u00ean h\u00ecnh \u1ea3nh nh\u01b0 m\u1ea3ng x\u01a1 v\u1eefa n\u1eb7ng tr\u00ean ch\u1ee5p m\u1ea1ch v\u00e0nh ho\u1eb7c c\u1eaft l\u1edbp vi t\u00ednh (CT), si\u00eau \u00e2m \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh\/\u0111\u00f9i ho\u1eb7c \u0111i\u1ec3m CAC cao.<\/li>\n
\u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng c\u00f3 t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u0111\u00edch ho\u1eb7c \u22653 y\u1ebfu t\u1ed1 nguy c\u01a1 l\u1edbn ho\u1eb7c \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 1 d\u1ea1ng kh\u1edfi ph\u00e1t s\u1edbm k\u00e9o d\u00e0i >20 n\u0103m.<\/li>\n
Suy th\u1eadn m\u1ea1n giai \u0111o\u1ea1n n\u1eb7ng (eGFR <30 mL\/ph\u00fat\/1.73m2).<\/li>\n
SCORE2 ho\u1eb7c SCORE2-OP \u226520% nguy c\u01a1 tim m\u1ea1ch 10 n\u0103m kh\u00f4ng t\u1eed vong v\u00e0 t\u1eed vong.<\/li>\n
R\u1ed1i lo\u1ea1n lipid gia \u0111\u00ecnh (FH) k\u00e8m ASCVD ho\u1eb7c m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 l\u1edbn kh\u00e1c.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Cao (High risk)<\/td>\n C\u00f3 m\u1ed9t trong c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m:<\/p>\n
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Y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u01a1n \u0111\u1ed9c t\u0103ng cao (T\u1ed5ng cholesterol >8 mmol\/L, LDL-C >4.9 mmol\/L, huy\u1ebft \u00e1p \u2265180\/110 mmHg).<\/li>\n
B\u1ec7nh nh\u00e2n R\u1ed1i lo\u1ea1n lipid gia \u0111\u00ecnh (FH) kh\u00f4ng k\u00e8m y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1c.<\/li>\n
\u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng kh\u00f4ng t\u1ed5n th\u01b0\u01a1ng \u0111\u00edch, th\u1eddi gian \u226510 n\u0103m ho\u1eb7c k\u00e8m y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1c. \u2022 Suy th\u1eadn m\u1ea1n v\u1eeba (eGFR 30-59 mL\/ph\u00fat\/1.73m2).<\/li>\n
SCORE2 ho\u1eb7c SCORE2-OP \u226510% v\u00e0 <20% nguy c\u01a1 tim m\u1ea1ch 10 n\u0103m.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Trung b\u00ecnh (Moderate risk)<\/td>\n C\u00f3 m\u1ed9t trong c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m:<\/p>\n
\n
B\u1ec7nh nh\u00e2n tr\u1ebb v\u1edbi \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 1 <35 tu\u1ed5i, type 2 <50 tu\u1ed5i, th\u1eddi gian <10 n\u0103m, kh\u00f4ng k\u00e8m y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1c.<\/li>\n
SCORE2 ho\u1eb7c SCORE2-OP t\u1eeb 2% \u0111\u1ebfn <10%.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Th\u1ea5p (Low risk)<\/td>\n SCORE2 ho\u1eb7c SCORE2-OP <2%.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
C\u00e1c y\u1ebfu t\u1ed1 \u0111i\u1ec1u ch\u1ec9nh nguy c\u01a1 c\u1ea7n xem x\u00e9t ngo\u00e0i vi\u1ec7c \u01b0\u1edbc t\u00ednh nguy c\u01a1 d\u1ef1a tr\u00ean thu\u1eadt to\u00e1n SCORE2 v\u00e0 SCORE2-OP<\/h2>\n\n\n\n\n
Nh\u00e2n kh\u1ea9u h\u1ecdc \u2013 L\u00e2m s\u00e0ng:<\/strong><\/p>\n
\n
Ti\u1ec1n s\u1eed gia \u0111\u00ecnh m\u1eafc b\u1ec7nh tim m\u1ea1ch s\u1edbm (nam: <55 tu\u1ed5i; n\u1eef: <60 tu\u1ed5i)<\/li>\n
D\u00e2n t\u1ed9c c\u00f3 nguy c\u01a1 cao (v\u00ed d\u1ee5: ng\u01b0\u1eddi Nam \u00c1)<\/li>\n
C\u00e1c tri\u1ec7u ch\u1ee9ng stress v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 g\u00e2y stress t\u00e2m l\u00fd x\u00e3 h\u1ed9i<\/li>\n
T\u00ecnh tr\u1ea1ng thi\u1ec7t th\u00f2i x\u00e3 h\u1ed9i<\/li>\n
B\u00e9o ph\u00ec<\/li>\n
Thi\u1ebfu ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t<\/li>\n
C\u00e1c b\u1ec7nh m\u1ea1n t\u00ednh do r\u1ed1i lo\u1ea1n mi\u1ec5n d\u1ecbch ho\u1eb7c vi\u00eam<\/li>\n
C\u00e1c r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n nghi\u00eam tr\u1ecdng<\/li>\n
Ti\u1ec1n s\u1eed m\u00e3n kinh s\u1edbm<\/li>\n
Ti\u1ec1n s\u1ea3n gi\u1eadt ho\u1eb7c c\u00e1c r\u1ed1i lo\u1ea1n t\u0103ng huy\u1ebft \u00e1p trong thai k\u1ef3<\/li>\n
Nhi\u1ec5m virus HIV<\/li>\n
H\u1ed9i ch\u1ee9ng t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng th\u1edf khi ng\u1ee7<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Ch\u1ec9 \u0111i\u1ec3m sinh h\u1ecdc:<\/strong><\/p>\n
\n
hs-CRP t\u0103ng k\u00e9o d\u00e0i (>2 mg\/L)<\/li>\n
Lp(a) t\u0103ng cao [>50 mg\/dL (>105 nmol\/L)]<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
$\"H\u00ecnh$
H\u00ecnh 1. M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb cholesterol lipoprotein t\u1ef7 tr\u1ecdng th\u1ea5p (LDL-C) theo c\u00e1c nh\u00f3m nguy c\u01a1 tim m\u1ea1ch to\u00e0n b\u1ed9<\/figcaption><\/figure>\n
Chi\u1ebfn l\u01b0\u1ee3c can thi\u1ec7p d\u1ef1a tr\u00ean nguy c\u01a1 tim m\u1ea1ch t\u1ed5ng th\u1ec3 v\u00e0 m\u1ee9c \u0111\u1ed9 LDL-C ch\u01b0a \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb<\/h2>\n\n\n\n\n\n\n\n\n\n
Nguy c\u01a1 tim m\u1ea1ch<\/td>\n M\u1ee9c LDL-C ch\u01b0a \u0111i\u1ec1u tr\u1ecb<\/td>\n<\/tr>\n
<1.4 mmol\/L<\/p>\n
(<55 mg\/dL)<\/td>\n
1.4 to <1.8 mmol\/L<\/p>\n
(55 to <70 mg\/dL)<\/td>\n
1.8 to <2.6 mmol\/L<\/p>\n
(70 to <100 mg\/dL)<\/td>\n
2.6 to <3.0 mmol\/L<\/p>\n
(100 to <116 mg\/dL)<\/td>\n
3.0 to <4.9 mmol\/L<\/p>\n
(116 to <190 mg\/dL<\/td>\n
\u22654.9 mmol\/L<\/p>\n
(\u2265190 mg\/dL)<\/td>\n<\/tr>\n
Th\u1ea5p<\/td>\n T\u01b0 v\u1ea5n thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng<\/td>\n T\u01b0 v\u1ea5n thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng<\/td>\n T\u01b0 v\u1ea5n thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng<\/td>\n T\u01b0 v\u1ea5n thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng<\/td>\n Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng, c\u00e2n nh\u1eafc b\u1ed5 sung thu\u1ed1c<\/td>\n N\/A<\/td>\n<\/tr>\n
Trung b\u00ecnh<\/td>\n T\u01b0 v\u1ea5n thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng<\/td>\n T\u01b0 v\u1ea5n thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng<\/td>\n T\u01b0 v\u1ea5n thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng<\/td>\n Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng, c\u00e2n nh\u1eafc b\u1ed5 sung thu\u1ed1c<\/td>\n Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng, c\u00e2n nh\u1eafc b\u1ed5 sung thu\u1ed1c<\/td>\n N\/A<\/td>\n<\/tr>\n
Cao<\/td>\n T\u01b0 v\u1ea5n thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng<\/td>\n T\u01b0 v\u1ea5n thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng<\/td>\n Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng, c\u00e2n nh\u1eafc b\u1ed5 sung thu\u1ed1c<\/td>\n Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng k\u1ebft h\u1ee3p \u0111i\u1ec1u tr\u1ecb thu\u1ed1c<\/td>\n Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng k\u1ebft h\u1ee3p \u0111i\u1ec1u tr\u1ecb thu\u1ed1c<\/td>\n Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng k\u1ebft h\u1ee3p \u0111i\u1ec1u tr\u1ecb thu\u1ed1c<\/td>\n<\/tr>\n
R\u1ea5t cao: Ph\u00f2ng ti\u00ean ph\u00e1t<\/td>\n Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng, c\u00e2n nh\u1eafc b\u1ed5 sung thu\u1ed1c<\/td>\n Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng, c\u00e2n nh\u1eafc b\u1ed5 sung thu\u1ed1c<\/td>\n Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng k\u1ebft h\u1ee3p \u0111i\u1ec1u tr\u1ecb thu\u1ed1c<\/td>\n Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng k\u1ebft h\u1ee3p \u0111i\u1ec1u tr\u1ecb thu\u1ed1c<\/td>\n Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng k\u1ebft h\u1ee3p \u0111i\u1ec1u tr\u1ecb thu\u1ed1c<\/td>\n Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng k\u1ebft h\u1ee3p \u0111i\u1ec1u tr\u1ecb thu\u1ed1c<\/td>\n<\/tr>\n
R\u1ea5t cao: Ph\u00f2ng th\u1ee9 ph\u00e1t<\/td>\n Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng k\u1ebft h\u1ee3p \u0111i\u1ec1u tr\u1ecb thu\u1ed1c<\/td>\n Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng k\u1ebft h\u1ee3p \u0111i\u1ec1u tr\u1ecb thu\u1ed1c<\/td>\n Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng k\u1ebft h\u1ee3p \u0111i\u1ec1u tr\u1ecb thu\u1ed1c<\/td>\n Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng k\u1ebft h\u1ee3p \u0111i\u1ec1u tr\u1ecb thu\u1ed1c<\/td>\n Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng k\u1ebft h\u1ee3p \u0111i\u1ec1u tr\u1ecb thu\u1ed1c<\/td>\n Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng k\u1ebft h\u1ee3p \u0111i\u1ec1u tr\u1ecb thu\u1ed1c<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
C\u00e1c khuy\u1ebfn c\u00e1o m\u1edbi<\/h2>\n
Khuy\u1ebfn c\u00e1o m\u1edbi (1)<\/h3>\n\n\n\n\n\n\n\n\n
Khuy\u1ebfn c\u00e1o<\/td>\n Class<\/td>\n Level<\/td>\n<\/tr>\n
\u0110\u00e1nh gi\u00e1 nguy c\u01a1 tim m\u1ea1ch \u1edf ng\u01b0\u1eddi kh\u00f4ng m\u1eafc b\u1ec7nh tim m\u1ea1ch \u0111\u00e3 bi\u1ebft<\/td>\n<\/tr>\n
SCORE2 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o d\u00f9ng cho ng\u01b0\u1eddi c\u00f3 v\u1ebb kh\u1ecfe m\u1ea1nh d\u01b0\u1edbi 70 tu\u1ed5i, kh\u00f4ng c\u00f3 ASCVD, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, suy th\u1eadn m\u1ea1n, c\u00e1c r\u1ed1i lo\u1ea1n lipid ho\u1eb7c huy\u1ebft \u00e1p di truy\u1ec1n\/\u00edt g\u1eb7p \u0111\u1ec3 \u01b0\u1edbc t\u00ednh nguy c\u01a1 t\u1eed vong v\u00e0 kh\u00f4ng t\u1eed vong do CVD trong 10 n\u0103m.<\/td>\n I<\/td>\n B<\/td>\n<\/tr>\n
SCORE2-OP \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o d\u00f9ng cho ng\u01b0\u1eddi c\u00f3 v\u1ebb kh\u1ecfe m\u1ea1nh t\u1eeb 70 tu\u1ed5i tr\u1edf l\u00ean, kh\u00f4ng c\u00f3 ASCVD, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, suy th\u1eadn m\u1ea1n, c\u00e1c r\u1ed1i lo\u1ea1n lipid ho\u1eb7c huy\u1ebft \u00e1p di truy\u1ec1n\/\u00edt g\u1eb7p \u0111\u1ec3 \u01b0\u1edbc t\u00ednh nguy c\u01a1 t\u1eed vong v\u00e0 kh\u00f4ng t\u1eed vong do CVD trong 10 n\u0103m.<\/td>\n I<\/td>\n B<\/td>\n<\/tr>\n
S\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch v\u00e0nh d\u01b0\u1edbi l\u00e2m s\u00e0ng qua h\u00ecnh \u1ea3nh ho\u1eb7c \u0111i\u1ec3m CAC t\u0103ng tr\u00ean CT n\u00ean \u0111\u01b0\u1ee3c xem nh\u01b0 c\u00e1c y\u1ebfu t\u1ed1 \u0111i\u1ec1u ch\u1ec9nh nguy c\u01a1 \u1edf ng\u01b0\u1eddi c\u00f3 nguy c\u01a1 trung b\u00ecnh ho\u1eb7c g\u1ea7n ng\u01b0\u1ee1ng quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 c\u1ea3i thi\u1ec7n ph\u00e2n lo\u1ea1i nguy c\u01a1.<\/td>\n IIa<\/td>\n B<\/td>\n<\/tr>\n
C\u00e1c y\u1ebfu t\u1ed1 \u0111i\u1ec1u ch\u1ec9nh nguy c\u01a1 n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t \u1edf ng\u01b0\u1eddi c\u00f3 nguy c\u01a1 trung b\u00ecnh ho\u1eb7c g\u1ea7n ng\u01b0\u1ee1ng quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 c\u1ea3i thi\u1ec7n ph\u00e2n lo\u1ea1i nguy c\u01a1.<\/td>\n IIb<\/td>\n B<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Khuy\u1ebfn c\u00e1o m\u1edbi (2)<\/h3>\n\n\n\n\n\n\n
Khuy\u1ebfn c\u00e1o<\/td>\n Class<\/td>\n Level<\/td>\n<\/tr>\n
\u0110\u00e1nh gi\u00e1 nguy c\u01a1 tim m\u1ea1ch \u1edf ng\u01b0\u1eddi kh\u00f4ng m\u1eafc b\u1ec7nh tim m\u1ea1ch \u0111\u00e3 bi\u1ebft (Ti\u1ebfp)<\/td>\n<\/tr>\n
Trong d\u1ef1 ph\u00f2ng ti\u00ean ph\u00e1t, \u0111i\u1ec1u tr\u1ecb thu\u1ed1c h\u1ea1 LDL-C \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho \u0111\u1ed1i t\u01b0\u1ee3ng:<\/p>\n
\n
C\u00f3 nguy c\u01a1 r\u1ea5t cao v\u00e0 LDL-C \u22651.8 mmol\/L (70 mg\/dL), ho\u1eb7c<\/li>\n
C\u00f3 nguy c\u01a1 cao v\u00e0 LDL-C \u22652.6 mmol\/L (100 mg\/dL) d\u00f9 \u0111\u00e3 t\u1ed1i \u01b0u c\u00e1c bi\u1ec7n ph\u00e1p thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng, nh\u1eb1m gi\u1ea3m nguy c\u01a1 tim m\u1ea1ch.<\/li>\n<\/ul>\n<\/td>\n
I<\/td>\n A<\/td>\n<\/tr>\n
Trong d\u1ef1 ph\u00f2ng ti\u00ean ph\u00e1t, n\u00ean c\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb thu\u1ed1c h\u1ea1 LDL-C cho<\/p>\n
\n
C\u00f3 nguy c\u01a1 r\u1ea5t cao v\u00e0 LDL-C t\u1eeb 1.4 mmol\/L (55 mg\/dL) \u0111\u1ebfn d\u01b0\u1edbi 1.8 mmol\/L (70 mg\/dL), ho\u1eb7c<\/li>\n
C\u00f3 nguy c\u01a1 cao v\u00e0 LDL-C t\u1eeb 1.8 mmol\/L (70 mg\/dL) \u0111\u1ebfn d\u01b0\u1edbi 2.6 mmol\/L (100 mg\/dL), ho\u1eb7c<\/li>\n
C\u00f3 nguy c\u01a1 trung b\u00ecnh v\u00e0 LDL-C t\u1eeb 2.6 mmol\/L (100 mg\/dL) \u0111\u1ebfn d\u01b0\u1edbi 4.9 mmol\/L (190 mg\/dL), ho\u1eb7c<\/li>\n
C\u00f3 nguy c\u01a1 th\u1ea5p v\u00e0 LDL-C t\u1eeb 3.0 mmol\/L (116 mg\/dL) \u0111\u1ebfn d\u01b0\u1edbi 4.9 mmol\/L (190 mg\/dL) d\u00f9 \u0111\u00e3 t\u1ed1i \u01b0u c\u00e1c bi\u1ec7n ph\u00e1p thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng, nh\u1eb1m gi\u1ea3m nguy c\u01a1 tim m\u1ea1ch<\/li>\n<\/ul>\n<\/td>\n
IIa<\/td>\n A<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
$\"H\u00ecnh$
H\u00ecnh 2. M\u1ee9c gi\u1ea3m trung b\u00ecnh cholesterol lipoprotein t\u1ef7 tr\u1ecdng th\u1ea5p (LDL-C) v\u1edbi c\u00e1c li\u1ec7u ph\u00e1p thu\u1ed1c kh\u00e1c nhau c\u00f3 l\u1ee3i \u00edch tim m\u1ea1ch \u0111\u01b0\u1ee3c ch\u1ee9ng minh<\/figcaption><\/figure>\n
Khuy\u1ebfn c\u00e1o m\u1edbi(3)<\/h3>\n\n\n\n\n\n\n\n\n
Khuy\u1ebfn c\u00e1o<\/td>\n Class<\/td>\n Level<\/td>\n<\/tr>\n
Khuy\u1ebfn ngh\u1ecb v\u1ec1 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb thu\u1ed1c LDL-C<\/td>\n<\/tr>\n
C\u00e1c thu\u1ed1c kh\u00f4ng ph\u1ea3i statin c\u00f3 l\u1ee3i \u00edch tim m\u1ea1ch \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh, d\u00f9ng \u0111\u01a1n l\u1ebb ho\u1eb7c ph\u1ed1i h\u1ee3p, \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho b\u1ec7nh nh\u00e2n kh\u00f4ng dung n\u1ea1p ho\u1eb7c kh\u00f4ng th\u1ec3 d\u00f9ng statin \u0111\u1ec3 h\u1ea1 LDL-C v\u00e0 gi\u1ea3m nguy c\u01a1 bi\u1ebfn c\u1ed1 tim m\u1ea1ch. L\u1ef1a ch\u1ecdn thu\u1ed1c d\u1ef1a tr\u00ean m\u1ee9c \u0111\u1ed9 gi\u1ea3m LDL-C b\u1ed5 sung c\u1ea7n thi\u1ebft.<\/td>\n I<\/td>\n A<\/td>\n<\/tr>\n
Bempedoic acid \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 d\u00f9ng statin \u0111\u1ec3 \u0111\u1ea1t m\u1ee5c ti\u00eau LDL-C.<\/td>\n I<\/td>\n B<\/td>\n<\/tr>\n
C\u1ea7n c\u00e2n nh\u1eafc th\u00eam bempedoic acid v\u00e0o li\u1ec1u statin t\u1ed1i \u0111a c\u00f3 th\u1ec3 dung n\u1ea1p, c\u00f3 ho\u1eb7c kh\u00f4ng k\u00e8m ezetimibe, \u1edf b\u1ec7nh nh\u00e2n nguy c\u01a1 cao ho\u1eb7c r\u1ea5t cao nh\u1eb1m \u0111\u1ea1t m\u1ee5c ti\u00eau LDL-C.<\/td>\n IIa<\/td>\n C<\/td>\n<\/tr>\n
Evinacumab n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t cho b\u1ec7nh nh\u00e2n t\u0103ng cholesterol gia \u0111\u00ecnh \u0111\u1ed3ng h\u1ee3p t\u1eed t\u1eeb 5 tu\u1ed5i tr\u1edf l\u00ean, kh\u00f4ng \u0111\u1ea1t m\u1ee5c ti\u00eau LDL-C d\u00f9 \u0111\u00e3 d\u00f9ng li\u1ec1u t\u1ed1i \u0111a c\u00e1c thu\u1ed1c h\u1ea1 lipid.<\/td>\n IIa<\/td>\n B<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Khuy\u1ebfn c\u00e1o m\u1edbi (4)<\/h3>\n\n\n\n\n\n\n
Khuy\u1ebfn c\u00e1o<\/td>\n Class<\/td>\n Level<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb h\u1ea1 lipid trong h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p (ACS)<\/td>\n<\/tr>\n
Vi\u1ec7c t\u0103ng c\u01b0\u1eddng \u0111i\u1ec1u tr\u1ecb h\u1ea1 lipid trong th\u1eddi gian nh\u1eadp vi\u1ec7n ACS \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111ang d\u00f9ng b\u1ea5t k\u1ef3 thu\u1ed1c h\u1ea1 lipid n\u00e0o tr\u01b0\u1edbc khi nh\u1eadp vi\u1ec7n nh\u1eb1m ti\u1ebfp t\u1ee5c h\u1ea1 LDL-C.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc kh\u1edfi \u0111\u1ea7u ph\u1ed1i h\u1ee3p \u0111i\u1ec1u tr\u1ecb v\u1edbi statin li\u1ec1u cao v\u00e0 ezetimibe trong th\u1eddi gian nh\u1eadp vi\u1ec7n ACS cho b\u1ec7nh nh\u00e2n ch\u01b0a t\u1eebng \u0111i\u1ec1u tr\u1ecb tr\u01b0\u1edbc \u0111\u00f3 v\u00e0 kh\u00f4ng k\u1ef3 v\u1ecdng \u0111\u1ea1t m\u1ee5c ti\u00eau LDL-C ch\u1ec9 v\u1edbi statin \u0111\u01a1n tr\u1ecb.<\/td>\n IIa<\/td>\n B<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
$\"H\u00ecnh$
H\u00ecnh 3. M\u1ed1i li\u00ean quan gi\u1eefa m\u1ee9c \u0111\u1ed9 Lp(a) v\u00e0 nguy c\u01a1 su\u1ed1t \u0111\u1eddi c\u1ee7a c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch l\u1edbn<\/figcaption><\/figure>\n
Khuy\u1ebfn c\u00e1o m\u1edbi (5)<\/h3>\n\n\n\n\n\n
Khuy\u1ebfn c\u00e1o<\/td>\n Class<\/td>\n Level<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o x\u00e9t nghi\u1ec7m lipoprotein(a)<\/td>\n<\/tr>\n
N\u1ed3ng \u0111\u1ed9 Lp(a) tr\u00ean 50 mg\/dL (105 nmol\/L) n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t \u1edf t\u1ea5t c\u1ea3 ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh nh\u01b0 m\u1ed9t y\u1ebfu t\u1ed1 l\u00e0m t\u0103ng nguy c\u01a1 tim m\u1ea1ch, v\u1edbi m\u1ee9c Lp(a) c\u00e0ng cao th\u00ec nguy c\u01a1 tim m\u1ea1ch c\u00e0ng t\u0103ng.<\/td>\n IIa<\/td>\n B<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Khuy\u1ebfn c\u00e1o m\u1edbi (6)<\/h3>\n\n\n\n\n\n\n
Khuy\u1ebfn c\u00e1o<\/td>\n Class<\/td>\n Level<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c cho b\u1ec7nh nh\u00e2n t\u0103ng triglyceride m\u00e1u<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng icosapent ethyl li\u1ec1u cao (2 l\u1ea7n m\u1ed7i ng\u00e0y, m\u1ed7i l\u1ea7n 2 g) ph\u1ed1i h\u1ee3p v\u1edbi statin \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao ho\u1eb7c r\u1ea5t cao, c\u00f3 m\u1ee9c triglyceride t\u0103ng (triglyceride l\u00fac \u0111\u00f3i 135\u2013499 mg\/dL ho\u1eb7c 1.52\u20135.63 mmol\/L) nh\u1eb1m gi\u1ea3m nguy c\u01a1 c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch.<\/td>\n IIa<\/td>\n B<\/td>\n<\/tr>\n
Volanesorsen (300 mg\/tu\u1ea7n) n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t cho b\u1ec7nh nh\u00e2n t\u0103ng triglyceride n\u1eb7ng (triglyceride >750 mg\/dL ho\u1eb7c >8.5 mmol\/L) do h\u1ed9i ch\u1ee9ng chylomicron m\u00e1u gia \u0111\u00ecnh, nh\u1eb1m h\u1ea1 triglyceride v\u00e0 gi\u1ea3m nguy c\u01a1 vi\u00eam t\u1ee5y c\u1ea5p.<\/td>\n IIa<\/td>\n B<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Khuy\u1ebfn c\u00e1o m\u1edbi (7)<\/h3>\n\n\n\n\n\n
Khuy\u1ebfn c\u00e1o<\/td>\n Class<\/td>\n Level<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb statin trong d\u1ef1 ph\u00f2ng ti\u00ean ph\u00e1t cho ng\u01b0\u1eddi nhi\u1ec5m HIV<\/td>\n<\/tr>\n
\u0110i\u1ec1u tr\u1ecb statin \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho ng\u01b0\u1eddi nhi\u1ec5m HIV trong d\u1ef1 ph\u00f2ng ti\u00ean ph\u00e1t t\u1eeb 40 tu\u1ed5i tr\u1edf l\u00ean, b\u1ea5t k\u1ec3 m\u1ee9c nguy c\u01a1 tim m\u1ea1ch \u01b0\u1edbc t\u00ednh v\u00e0 m\u1ee9c LDL-C, nh\u1eb1m gi\u1ea3m nguy c\u01a1 bi\u1ebfn c\u1ed1 tim m\u1ea1ch. Vi\u1ec7c l\u1ef1a ch\u1ecdn lo\u1ea1i statin c\u1ea7n c\u0103n c\u1ee9 v\u00e0o kh\u1ea3 n\u0103ng t\u01b0\u01a1ng t\u00e1c thu\u1ed1c ti\u1ec1m t\u00e0ng.<\/td>\n I<\/td>\n B<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Khuy\u1ebfn c\u00e1o m\u1edbi (8)<\/h3>\n\n\n\n\n\n
Khuy\u1ebfn c\u00e1o<\/td>\n Class<\/td>\n Level<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb statin cho b\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb ung th\u01b0<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng statin \u1edf b\u1ec7nh nh\u00e2n ng\u01b0\u1eddi l\u1edbn c\u00f3 nguy c\u01a1 cao ho\u1eb7c r\u1ea5t cao ph\u00e1t tri\u1ec3n \u0111\u1ed9c t\u00ednh tim m\u1ea1ch do h\u00f3a tr\u1ecb, nh\u1eb1m gi\u1ea3m nguy c\u01a1 t\u1ed5n th\u01b0\u01a1ng ch\u1ee9c n\u0103ng tim do anthracycline.<\/td>\n IIa<\/td>\n B<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Khuy\u1ebfn c\u00e1o m\u1edbi (9)<\/h3>\n\n\n\n\n\n
Khuy\u1ebfn c\u00e1o<\/td>\n Class<\/td>\n Level<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o v\u1ec1 th\u1ef1c ph\u1ea9m ch\u1ee9c n\u0103ng<\/td>\n<\/tr>\n
Kh\u00f4ng khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng c\u00e1c th\u1ef1c ph\u1ea9m ch\u1ee9c n\u0103ng ho\u1eb7c vitamin ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ee9ng minh c\u00f3 \u0111\u1ed9 an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 \u0111\u00e1ng k\u1ec3 trong vi\u1ec7c h\u1ea1 LDL-C \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh x\u01a1 v\u1eefa (ASCVD).<\/td>\n III<\/td>\n B<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n","protected":false},"excerpt":{"rendered":"
Khoa N\u1ed9i tim m\u1ea1ch \u2013 Vi\u1ec7n tim m\u1ea1ch B\u1ec7nh vi\u1ec7n Trung \u01b0\u01a1ng Qu\u00e2n \u0111\u1ed9i 108 T\u1ea3i PDF T\u1ea1i \u0111\u00e2y. H\u01b0\u1edbng d\u1eabn ESC v\u1ec1 qu\u1ea3n l\u00fd r\u1ed1i lo\u1ea1n lipid m\u00e1u The material was adapted from the \u20182025 Focused Update of the 2019 ESC\/EAS Guidelinesfor the management of dyslipidaemias\u2019 European Heart Journal; doi:10.1093\/eurheartj\/ehaf190; as published on 29 […]\n","protected":false},"author":1,"featured_media":137779,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-137090","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/137090","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=137090"}],"version-history":[{"count":9,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/137090\/revisions"}],"predecessor-version":[{"id":137775,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/137090\/revisions\/137775"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/137779"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=137090"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=137090"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=137090"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}