Ververs M T, Verschuren W M, Boerma G J, Kromhout D
Rijksinstituut voor Volksgezondheid en Milieuhygiëne, Centrum voor Epidemiologie, Bilthoven.
Ned Tijdschr Geneeskd. 1992 May 23;136(21):1023-7.
The evidence is growing that not only total cholesterol, but also HDL cholesterol is an important predictor of coronary heart disease. In the Framingham Study, the total cholesterol/HDL cholesterol ratio gave the best prediction for the coronary heart disease risk. With data of the Netherlands Monitoring Risk Factor Project it was investigated to what extent persons with a high ratio (greater than or equal to 7) were identified when the criteria of the Netherlands Cholesterol Consensus were applied. Between 1987 and 1989 total and HDL cholesterol were determined in about 22,000 men and women aged 20-59. Twenty per cent of the men had hypercholesterolaemia (total cholesterol greater than or equal to 6.5 mmol/l). Of the hypercholesterolaemic men, 60 per cent did not have a high total/HDL cholesterol ratio. Eighteen per cent of the women were hypercholesterolaemic. Of all hypercholesterolaemic women, 80 per cent did not have a high total/HDL cholesterol ratio. Therefore, it is important that after a first screening on total cholesterol, HDL cholesterol is measured at the second cholesterol determination. Subsequently, a decision about treatment should be made, based on the total/HDL cholesterol ratio and the presence of other risk factors (hypertension, smoking, obesity, diabetes and a family history of cardiovascular disease.
越来越多的证据表明，不仅总胆固醇，高密度脂蛋白胆固醇也是冠心病的重要预测指标。在弗明汉姆研究中，总胆固醇与高密度脂蛋白胆固醇的比值对冠心病风险的预测效果最佳。利用荷兰监测风险因素项目的数据，研究了应用荷兰胆固醇共识标准时，高比值（大于或等于7）人群的识别程度。1987年至1989年期间，对约22000名年龄在20至59岁的男性和女性测定了总胆固醇和高密度脂蛋白胆固醇。20%的男性患有高胆固醇血症（总胆固醇大于或等于6.5毫摩尔/升）。在高胆固醇血症男性中，60%的人总胆固醇与高密度脂蛋白胆固醇的比值不高。18%的女性患有高胆固醇血症。在所有高胆固醇血症女性中，80%的人总胆固醇与高密度脂蛋白胆固醇的比值不高。因此，重要的是在首次筛查总胆固醇后，第二次测定胆固醇时测量高密度脂蛋白胆固醇。随后，应根据总胆固醇与高密度脂蛋白胆固醇的比值以及其他风险因素（高血压、吸烟、肥胖、糖尿病和心血管疾病家族史）做出治疗决定。
