針對肥胖、糖尿病及非透析性慢性腎臟病之初級預防藥物治療

Pharmacological Interventions for Obesity, Diabetes Mellitus, and Non-Dialysis Chronic Kidney Disease for Primary Prevention of ASCVD

本文彙整中華民國心臟學會治療指引針對肥胖、糖尿病及慢性腎臟病病人，提供動脈粥狀硬化心血管疾病（Atherosclerotic Cardiovascular Disease，ASCVD）初級預防的建議。肥胖依據台灣定義，身體質量指數（Body Mass Index，BMI）≥24 kg／m²視為過重，≥27 kg／m²為肥胖。肥胖顯著增加心血管風險。建議透過飲食與運動減重5-10%。若成效不彰，針對BMI≥30 kg／m²或≥27 kg／m²且合併共病者，建議使用藥物，如GLP-1受體促效劑、Orlistat或Naltrexone／Bupropion ER。糖尿病盛行率持續上升，且被視為冠狀動脈疾病等效因子。為預防ASCVD，建議將糖化血色素控制於< 7.0%。治療首選具心血管保護實證之GLP-1受體促效劑及SGLT2抑制劑。慢性腎臟病為ASCVD高風險因。針對非透析病人，建議控制居家血壓< 130／80 mmHg及低密度脂蛋白膽固醇（LDL-C）< 100 mg／dL。強烈建議使用具腎臟保護作用藥物，包括ACEI／ARB、SGLT2抑制劑、GLP-1受體促效劑及Finerenone，以改善心腎預後。

This article summarizes the Taiwan Society of Cardiology (TSOC) guidelines recommendations for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) in patients with obesity, diabetes mellitus (DM), and chronic kidney disease (CKD). Obesity, according to definitions in Taiwan, a Body Mass Index (BMI)≥24 kg/m²is considered overweight, and≥27 kg/m²is considered obese. Obesity significantly increases cardiovascular risk. Weight loss of 5-10% through diet and exercise is recommended. If these measures are ineffective, pharmacotherapy, such as GLP-1 receptor agonists, Orlistat, or Naltrexone/Bupropion ER, is recommended for patients with a BMI≥30 kg/m², or≥27 kg/m with comorbidities. The prevalence of diabetes in Taiwan continues to rise, and it is considered a coronary artery disease risk equivalent. To prevent ASCVD, it is recommended to control hemoglobin A1c to < 7.0%. The preferred treatment strategies involve GLP-1 receptor agonists and SGLT2 inhibitors that have proven cardiovascular protection benefits.CKD is a high-risk factor for ASCVD. For non-dialysis CKD patients, it is recommended to control home blood pressure to < 130/80 mmHg and LDL-C to < 100 mg/dL. Pharmacological interventions strongly recommend the use of agents with renoprotective effects, including ACEIs/ARBs, SGLT2 inhibitors, GLP-1 receptor agonists, and Finerenone, to improve cardiorenal outcomes.