Rubins H B, Schectman G, Wilt T J, Iwane M K
Department of Veterans Affairs Medical Center, Boston, Mass.
Arch Intern Med. 1992 Dec;152(12):2412-6.
Risk factor modification, including treatment of dyslipidemias, has been recommended for the prevention of future coronary events in patients with coronary heart disease (CHD). Since the prevalence of various dyslipidemias among outpatients with CHD has not been well documented, the purpose of this study was to determine the frequency of specific lipid phenotypes among ambulatory men with CHD.
Lipid profiles were obtained in 255 men (mean age, 65.5 +/- 9.1 years) with CHD in three Veterans Affairs medical centers. Desirable levels of lipids were defined according to National Cholesterol Education Program guidelines as follows: low-density lipoprotein cholesterol (LDL-C) levels less than 3.36 mmol/L (130 mg/dL); high-density lipoprotein cholesterol (HDL-C) levels equal to or greater than 0.90 mmol/L (35 mg/dL); and triglyceride levels less than 2.83 mmol/L.
Seventy-six percent of the group had one or more abnormalities on lipid profile: 51% had high LDL-C levels with or without abnormalities of HDL-C and/or triglyceride levels; 22% had low HDL-C levels with desirable levels of LDL-C; and 3% had hypertriglyceridemia without any cholesterol abnormalities. Normal lipid profiles were significantly more prevalent in subjects over the age of 65 years than in younger patients (40% vs 14%).
These data suggest that (1) a high proportion of men with CHD have dyslipidemia, including 50% with LDL-C level elevations. For these men, the potential benefits of therapeutic intervention have been documented in clinical trials, although the cost-efficiency of wide-scale treatment has not been determined; (2) isolated hypertriglyceridemia is rare in this population; and (3) low HDL-C levels in association with desirable LDL-C levels are present in more than one fifth of male patients with CHD. Clinical trials focusing on this large group are urgently needed to determine whether efforts to raise HDL-C levels result in reduced cardiac morbidity and/or mortality.
为预防冠心病（CHD）患者未来发生冠状动脉事件，已建议对危险因素进行干预，包括治疗血脂异常。由于CHD门诊患者中各种血脂异常的患病率尚无充分记录，本研究旨在确定CHD男性门诊患者中特定血脂表型的频率。
在三个退伍军人事务医疗中心，对255名患有CHD的男性（平均年龄65.5±9.1岁）进行了血脂检测。根据国家胆固醇教育计划指南，将理想血脂水平定义如下：低密度脂蛋白胆固醇（LDL-C）水平低于3.36 mmol/L（130 mg/dL）；高密度脂蛋白胆固醇（HDL-C）水平等于或高于0.90 mmol/L（35 mg/dL）；甘油三酯水平低于2.83 mmol/L。
该组76%的患者存在一项或多项血脂异常：51%的患者LDL-C水平升高，伴或不伴有HDL-C和/或甘油三酯水平异常；22%的患者HDL-C水平低，而LDL-C水平正常；3%的患者甘油三酯血症，无任何胆固醇异常。65岁以上患者的正常血脂谱比年轻患者更常见（40%对14%）。
这些数据表明：（1）很大比例的CHD男性患有血脂异常，其中50%的患者LDL-C水平升高。对于这些男性，临床试验已证明治疗性干预具有潜在益处，尽管大规模治疗的成本效益尚未确定；（2）在该人群中，单纯高甘油三酯血症很少见；（3）超过五分之一的CHD男性患者HDL-C水平低，而LDL-C水平正常。迫切需要针对这一庞大群体开展临床试验，以确定提高HDL-C水平的措施是否能降低心脏发病率和/或死亡率。
