Getz Linn, Kirkengen Anna Luise, Hetlevik Irene, Romundstad Solfrid, Sigurdsson Johann A
Office of Human Resources, Landspitali University Hospital, Reykjavik, Iceland.
Scand J Prim Health Care. 2004 Dec;22(4):202-8. doi: 10.1080/02813430410006693.
Our first objective is to describe total, age- and gender-specific prevalences of subjects in a well-defined population for whom medical follow-up is indicated due to unfavourably high blood pressure and/or cholesterol levels, as defined by the 2003 European guidelines on cardiovascular disease prevention in clinical practice. Our second objective is to highlight scientific questions and ethical dilemmas relating to implementation of the guidelines.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional population study comprising 62104 adult Norwegians aged 20-79 years who participated in The Nord-Tröndelag Health Study 1995--97.
Total, age- and gender-specific point prevalences of individuals with total cholesterol > or =5 mmol/l and/or systolic blood pressure > or =140 mmHg and/or diastolic blood pressure > or =90 mmHg, or taking antihypertensive medication.
In total, 76% of individuals aged 20-79 years have an "unfavourable" cardiovascular disease risk profile, according to guideline definitions. The point prevalence of individuals with cholesterol and/or blood pressure above the recommended cut-off points increases with age. By age 24, the prevalence reaches 50%. By age 49, it reaches 90%. Men below 50 years of age have higher combined risk prevalence than women.
Implementation of the 2003 European guidelines on CVD prevention would label a large majority of Norwegian adults as having unfavourably high cholesterol and/or blood pressure levels. The current biomedical standards appear to invalidate demographic health statistics. The theoretical basis on which the guidelines rest should thereby be scrutinized with regard to scientific methodology and consistency. Important ethical dilemmas arise at the point of guideline implementation, relating to risk labelling and medicalization, as well as resource allocation and sustainability within the healthcare system.
我们的首要目标是描述在一个明确界定的人群中，因血压和/或胆固醇水平过高（按照2003年欧洲临床实践心血管疾病预防指南所定义）而需要医学随访的人群的总体患病率，以及按年龄和性别的特定患病率。我们的第二个目标是突出与指南实施相关的科学问题和伦理困境。
设计、背景与参与者：横断面人群研究，涵盖了62104名年龄在20 - 79岁之间的挪威成年人，他们参与了1995 - 1997年的北特伦德拉格健康研究。
总胆固醇≥5 mmol/l和/或收缩压≥140 mmHg和/或舒张压≥90 mmHg，或正在服用抗高血压药物的个体的总体患病率，以及按年龄和性别的特定患病率。
根据指南定义，在20 - 79岁的人群中，总计76%的人有“不良”的心血管疾病风险状况。胆固醇和/或血压高于推荐切点的个体的时点患病率随年龄增加而上升。到24岁时，患病率达到50%。到49岁时，达到90%。50岁以下男性的综合风险患病率高于女性。
实施2003年欧洲心血管疾病预防指南会将绝大多数挪威成年人标记为胆固醇和/或血压水平过高。当前的生物医学标准似乎使人口健康统计数据无效。因此，应从科学方法和一致性方面审视该指南所依据的理论基础。在指南实施过程中会出现重要的伦理困境，涉及风险标记和医学化，以及医疗保健系统内的资源分配和可持续性。
