Borgers Dieter
Abteilung für Allgemeinmedizin, Universitätsklinikum Düsseldorf.
Z Arztl Fortbild Qualitatssich. 2003 Feb;97(1):19-26.
The measurement of cholesterol levels is a routinely used test which, is claimed to be also a screening test. However, true screening for familial hypercholesterolemia in young people must be distinguished from the so-called risk factor screening among adults, which in Germany is performed both systematically in the whole population and even more so incidentally. This risk factor approach to the measurement of cholesterol is neither a screening test nor does it aim to detect a disease early, but the rationale is a risk factor medicine approach, which has to be evaluated according to its own requirements. The technical efficiency of cholesterol measurement as a screening test is so low, that the notion of screening represents a misnomer and a category error. The measurement of risk factors in a screening context and as a method of individual primary preventive medicine has led to unsolvable problems. A consensus has been achieved, that only a multiple risk factor approach is worthwhile, though the individual and the community approach are both only marginally effective in primary prevention, as has been shown in meta-analyses. Prescription for chemoprophylaxis with statins has shown a relevant risk reduction, but has only been evaluated as a high-risk approach with a cardiovascular risk of 2-3% per year.
胆固醇水平测量是一项常规使用的检测，据称它也是一种筛查检测。然而，对年轻人进行家族性高胆固醇血症的真正筛查必须与成年人中的所谓风险因素筛查区分开来，在德国，这种筛查在整个人口中都有系统地进行，甚至更多是偶然进行。这种将胆固醇测量作为风险因素的方法既不是筛查检测，也不是旨在早期发现疾病，其原理是风险因素医学方法，必须根据其自身要求进行评估。胆固醇测量作为筛查检测的技术效率非常低，以至于筛查这个概念是用词不当和类别错误。在筛查背景下以及作为个体一级预防医学方法的风险因素测量导致了无法解决的问题。已经达成共识，即只有多风险因素方法才是值得的，尽管个体和社区方法在一级预防中都只是略有成效，正如荟萃分析所表明的那样。使用他汀类药物进行化学预防的处方已显示出相关的风险降低，但仅被评估为每年心血管风险为2 - 3%的高风险方法。
