Gotto A M
Joan and Sanford I. Weill Medical College of Cornell University, New York 10021, USA.
Am J Med. 1999 Aug 23;107(2A):36S-39S. doi: 10.1016/s0002-9343(99)00145-x.
The results of AFCAPS/TexCAPS provide strong evidence for the benefits of primary prevention through lipid-regulating treatment across the spectrum of clinical coronary events that are often the first manifestations of atherosclerotic disease. These results reinforce current NCEP guidelines and demonstrate the need for the inclusion of HDL-C in clinical evaluations. The clear benefit observed in AFCAPS/TexCAPS reinforces the need to implement treatment in all individuals with average LDL-C and low HDL-C who may be at risk for CHD. According to estimates based on phase-2 NHANES III data (1991-1994), only 1.4 million (6.6%) of 21.1 million American adults eligible for cholesterol-lowering drug therapy by NCEP guidelines were receiving such therapy, including 14% of those eligible in secondary prevention and 4% of those eligible in primary prevention. Of diet- or drug-eligible adults, 65% received no therapy of any kind. Undertreatment of dyslipidemia continues to be a problem today. These statistics suggest that physicians must improve their efforts to reverse the toll of atherosclerotic disease through risk factor management.
AFCAPS/TexCAPS研究结果为通过血脂调节治疗进行一级预防在一系列临床冠状动脉事件中的益处提供了有力证据，这些事件往往是动脉粥样硬化疾病的首发表现。这些结果强化了当前的NCEP指南，并表明在临床评估中纳入高密度脂蛋白胆固醇（HDL-C）的必要性。在AFCAPS/TexCAPS研究中观察到的明确益处强化了对所有低密度脂蛋白胆固醇（LDL-C）水平正常但HDL-C水平低且可能有冠心病风险的个体实施治疗的必要性。根据基于第二阶段美国国家健康与营养检查调查（NHANES III，1991 - 1994年）数据的估计，在2110万符合NCEP指南胆固醇降低药物治疗条件的美国成年人中，只有140万（6.6%）接受了此类治疗，其中二级预防中符合条件者的接受率为14%，一级预防中符合条件者的接受率为4%。在符合饮食或药物治疗条件的成年人中，65%未接受任何治疗。血脂异常治疗不足如今仍然是一个问题。这些统计数据表明，医生必须加大力度，通过危险因素管理来扭转动脉粥样硬化疾病造成的损害。
