Erhardt L R, Hobbs F D R
Department of Cardiology, Lund University, Malmö University Hospital, Malmö, Sweden.
Int J Clin Pract. 2007 Jul;61(7):1078-85. doi: 10.1111/j.1742-1241.2007.01420.x.
Guidelines for cardiovascular disease (CVD) prevention cite high levels of low-density lipoprotein cholesterol (LDL-C) as a major risk factor and recommend LDL-C goals for various risk groups. Lifestyle changes are advised as first-line treatment for patients with high cholesterol, and statins are recommended in high-risk patients. The From The Heart study investigated current practice for the diagnosis and treatment of high cholesterol, and attitudes towards management of the condition.
Physicians were randomly selected from 10 countries, and completed a confidential, semi-structured questionnaire.
Of 2790 physicians agreeing to participate, 750 (27%) responded. Physicians rated CVD as the leading cause of death, although physicians (80%) perceived that cancer was the most feared illness among patients. Physicians (71%) believed smoking to be the greatest CVD risk factor, while only 50% thought high cholesterol was the greatest risk. Most physicians (81%) used guidelines to set cholesterol goals, primarily their national guidelines (34%) or the National Cholesterol Education Program Adult Treatment Panel III guidelines (24%). Although only 47% of patients reached and maintained their cholesterol goals, 61% of physicians believed that a sufficient number of patients achieved goals, and 53% did not feel frustrated that they could not always effectively treat patients with CVD.
Results indicate discrepancies between guideline recommendations and clinical practice. Although physicians appreciate the risk of CVD, the importance of achieving healthy cholesterol levels for CVD prevention does not seem to be widely endorsed. There is a need for improved communication regarding the importance of cholesterol lowering and investigation of initiatives to improve goal achievement among physicians.
心血管疾病（CVD）预防指南将低密度脂蛋白胆固醇（LDL-C）水平升高列为主要危险因素，并针对不同风险群体推荐了LDL-C目标。建议生活方式改变作为高胆固醇患者的一线治疗方法，高危患者推荐使用他汀类药物。“发自内心”研究调查了高胆固醇诊断和治疗的当前实践以及对该疾病管理的态度。
从10个国家随机选择医生，并完成一份保密的半结构化问卷。
在2790名同意参与的医生中，750名（27%）做出了回应。医生将CVD列为主要死因，尽管医生（80%）认为癌症是患者最恐惧的疾病。医生（71%）认为吸烟是最大的CVD危险因素，而只有50%的医生认为高胆固醇是最大风险。大多数医生（81%）使用指南来设定胆固醇目标，主要是本国指南（34%）或国家胆固醇教育计划成人治疗小组第三次指南（24%）。尽管只有47%的患者达到并维持了他们的胆固醇目标，但61%的医生认为有足够数量的患者实现了目标，并且53%的医生对于不能总是有效治疗CVD患者并不感到沮丧。
结果表明指南建议与临床实践之间存在差异。尽管医生认识到CVD的风险，但实现健康胆固醇水平对预防CVD的重要性似乎并未得到广泛认可。需要就降低胆固醇的重要性进行更好的沟通，并对提高医生中目标达成率的举措进行调查。
