Crouch M A
Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas 77005, USA.
Am Fam Physician. 2001 Jan 15;63(2):309-20, 323-4.
Primary and secondary prevention trials have shown that use of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (also known as statins) to lower an elevated low-density lipoprotein cholesterol level can substantially reduce coronary events and death from coronary heart disease. In 1987 and 1993, the National Cholesterol Education Program promulgated guidelines for cholesterol screening and treatment. Thus far, however, primary care physicians have inadequately adopted these guidelines in clinical practice. A 1991 study found that cholesterol screening was performed in only 23 percent of patients. Consequently, many patients with elevated low-density lipoprotein levels and a high risk of primary or recurrent ischemic events remain unidentified and untreated. A study published in 1998 found that fewer than 15 percent of patients with known coronary heart disease have low-density lipoprotein levels at the recommended level of below 100 mg per dL (2.60 mmol per L). By identifying patients with elevated low-density lipoprotein levels and instituting appropriate lipid-lowering therapy, family physicians could help prevent cardiovascular events and death in many of their patients.
一级和二级预防试验表明，使用3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂（也称为他汀类药物）降低升高的低密度脂蛋白胆固醇水平可显著减少冠心病事件和冠心病死亡。1987年和1993年，国家胆固醇教育计划颁布了胆固醇筛查和治疗指南。然而，到目前为止，初级保健医生在临床实践中对这些指南的采用并不充分。1991年的一项研究发现，只有23%的患者进行了胆固醇筛查。因此，许多低密度脂蛋白水平升高且有原发性或复发性缺血事件高风险的患者仍未被识别和治疗。1998年发表的一项研究发现，已知患有冠心病的患者中，低密度脂蛋白水平低于推荐水平每分升100毫克（每升2.60毫摩尔）的不到15%。通过识别低密度脂蛋白水平升高的患者并进行适当的降脂治疗，家庭医生可以帮助许多患者预防心血管事件和死亡。
