他汀類藥物、阿斯匹靈與Omega-3魚油於初級預防之角色

The Role of Statins, Aspirin, and Omega-3 Fish Oil in Primary Prevention of ASCVD

動脈粥樣硬化心血管疾病（atherosclerotic cardiovascular disease，ASCVD）是造成全球及台灣民眾死亡與致殘的主因，其病程演進長達數十年。初級預防之核心，在於首發事件發生前的風險干預。他汀類藥物（statins），作為降低低密度脂蛋白膽固醇（low-density lipoprotein cholesterol，LDL-C）的首選藥物，其證據強度最高（class I，LOE A），臨床上強調應依據風險分層設定LDL-C目標值，並關注長期累積暴露量對斑塊穩定的影響。阿斯匹靈（aspirin）的角色近年因出血風險考量，而出現大幅修正，目前不再建議於一般族群中例行使用，而是轉向以冠狀動脈鈣化評分（coronary artery calcium，CAC）為導引的精準預防策略（class IIb）。魚油（omega-3）的預防效益則與成分純度高度相關：高劑量純EPA（icosapent ethyl）在大型試驗（如REDUCE-IT）中，證實能顯著降低statins治療後的殘餘風險，而混合型魚油（EPA／DHA）則缺乏一致的臨床證據。本文整合中華民國心臟學會最新指引建議，為臨床決策提供系統化框架，強調醫病共同決策在初級預防中的價值。

Atherosclerotic Cardiovascular Disease (ASCVD) is a major contributor to global morbidity and mortality. Primary prevention strategies focus on mitigating risks before the first clinical cardiovascular event. Statins remain the cornerstone of therapy (Class I, LOE A), effectively lowering low-density lipoprotein cholesterol (LDL-C) and promoting plaque stabilization. Current guidelines emphasize risk-stratified LDL-C targets and the critical role of managing ''cumulative LDL-C exposure.'' The clinical use of Aspirin in primary prevention has undergone significant restriction due to concerns that bleeding risks may outweigh cardiovascular benefits; hence, it is no longer recommended for routine use. Instead, a personalized strategy guided by Coronary Artery Calcium (CAC) scores is advocated for specific high-risk cohorts (Class IIb). The efficacy of Omega-3 fish oil is contingent on formulation: high-purity EPA (Icosapent Ethyl) has demonstrated significant cardiovascular protection in patients with residual risk (e.g., the REDUCE-IT trial), whereas mixed EPA/DHA supplements have failed to show consistent clinical benefits. This report summarizes the Taiwan Society of Cardiology guidelines and major clinical trial evidence to provide a systematic framework for primary prevention, highlighting the importance of shared decision-making in personalized clinical practice.