Clearfield Michael, Downs John R, Lee Michael, Langendorfer Alex, McConathy Walter, Gotto Antonio M
Department of Internal Medicine, University of North Texas Health Science Center, Fort Worth, Texas, USA.
Am J Cardiol. 2005 Dec 15;96(12):1674-80. doi: 10.1016/j.amjcard.2005.07.079. Epub 2005 Nov 2.
The Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) first reported its results in 1998, before the 2001 publication of the National Cholesterol Education Program-Adult Treatment Panel III guidelines (NCEP-ATP III) and 2004 update. Our objective was to investigate the impact of these guidelines on the AFCAPS/TexCAPS cohort. The main outcome measures were the event rates of first acute major coronary events (AMCEs), which were reduced 39% by lovastatin (95% confidence interval [CI] 21% to 53%, p <0.001) in the 65% of the cohort eligible for drug therapy and by 34% (95% CI -9% to 60%, p = 0.108) in the remaining 35% for whom drug therapy was considered optional. The evaluation of other guideline components included a 44% (95% CI 27% to 58%, p <0.001) reduction in AMCEs in subjects with baseline high-density lipoprotein cholesterol <40 mg/dl and a 41% (95% CI 19% to 57%) reduction in AMCEs in subjects with the metabolic syndrome. In the recent update, patients who had a moderately high risk of coronary heart disease and a baseline low-density lipoprotein cholesterol level of 100 to 130 mg/dl could be considered for therapy with a medication to lower the low-density lipoprotein cholesterol level to <100 mg/dl. A total of 334 subjects (5.1%) were in this group, in whom lovastatin reduced the risk of AMCEs by 68% (95% CI 12% to 88%, p = 0.027). However, 21% of the AMCEs were missed by the guidelines. Metabolic syndrome was noted in 48% of these subjects and may help define those in whom treatment with a medication is now considered optional. In conclusion, the ability of the ATP III guidelines and its update has markedly improved our ability to define coronary heart disease risk; however, other components of the guidelines, such as non-high-density lipoprotein cholesterol and the optional low-density lipoprotein cholesterol target goal of <100 mg/dl, still require additional evaluation.
空军/德克萨斯州冠状动脉粥样硬化预防研究（AFCAPS/TexCAPS）于1998年首次公布其结果，早于2001年《国家胆固醇教育计划成人治疗小组第三次报告》（NCEP-ATP III）指南的发布以及2004年的更新。我们的目的是研究这些指南对AFCAPS/TexCAPS队列的影响。主要结局指标是首次急性主要冠状动脉事件（AMCE）的发生率，在符合药物治疗条件的队列中65%的患者中，洛伐他汀使该发生率降低了39%（95%置信区间[CI]为21%至53%，p<0.001），而在其余35%被认为药物治疗为可选项的患者中，该发生率降低了34%（95%CI为-9%至60%，p = 0.108）。对其他指南成分的评估包括，基线高密度脂蛋白胆固醇<40mg/dl的受试者中AMCE发生率降低了44%（95%CI为27%至58%，p<0.001），以及代谢综合征患者中AMCE发生率降低了41%（95%CI为19%至57%）。在最近的更新中，对于冠心病中度高危且基线低密度脂蛋白胆固醇水平为100至130mg/dl的患者，可考虑使用药物治疗将低密度脂蛋白胆固醇水平降至<100mg/dl。共有334名受试者（5.1%）属于这一组，其中洛伐他汀使AMCE风险降低了68%（95%CI为12%至88%，p = 0.027）。然而，这些指南遗漏了21%的AMCE。这些受试者中有48%被发现患有代谢综合征，这可能有助于确定目前被认为药物治疗为可选项的人群。总之，ATP III指南及其更新显著提高了我们定义冠心病风险的能力；然而，该指南的其他成分，如非高密度脂蛋白胆固醇以及可选的低密度脂蛋白胆固醇目标值<100mg/dl，仍需要进一步评估。
