Kraushaar Lutz E, Krämer Alexander
Department of Public Health Medicine, University of Bielefeld, Bielefeld, Germany.
BMC Public Health. 2009 Feb 21;9:64. doi: 10.1186/1471-2458-9-64.
Cardiovascular and diabetic disease are the leading and preventable causes of death worldwide. The currently prognosticated dramatic increase in disease burden over the next two decades, however, bespeaks a low confidence in our prevention ability. This conflicts with the almost enthusiastic reporting of study results, which demonstrate substantial risk reductions secondary to simple lifestyle changes.
There is a case to be made for a disregard of the difference between statistical significance and clinical relevance of the reported data. Nevertheless, lifestyle change remains the main weapon in our battle against the epidemic of cardiometabolic disease. But along the way from risk screening to intervention to maintenance the compound inefficiencies of current primary preventive strategies marginalize their impact.
Unless we dramatically change the ways in which we deploy preventive interventions we will inevitably lose the battle. In this paper we will argue for three provocative strategy changes, namely (a) the disbanding of screening in favor of population-wide enrollment into preventive interventions, (b) the substitution of the current cost utility analysis for a return-on-investment centered appraisal of interventions, and (c) the replacement of standardized programs modeled around acute care by individualized and perpetual interventions.
心血管疾病和糖尿病是全球主要的可预防死因。然而，据目前预测，在未来二十年疾病负担将急剧增加，这表明我们对预防能力缺乏信心。这与对研究结果几乎热情洋溢的报道相矛盾，这些研究结果表明，简单的生活方式改变能大幅降低风险。
有理由忽略所报告数据的统计学意义和临床相关性之间的差异。尽管如此，生活方式改变仍然是我们对抗心脏代谢疾病流行的主要武器。但是，从风险筛查到干预再到维持，当前初级预防策略存在的复合低效问题削弱了它们的影响。
除非我们大幅改变实施预防性干预的方式，否则我们将不可避免地输掉这场战斗。在本文中，我们将主张三项具有启发性的策略变革，即：（a）取消筛查，转而让全体人群参与预防性干预；（b）用基于投资回报率的干预评估取代当前的成本效用分析；（c）用个性化和持续性干预取代围绕急性护理模式制定的标准化项目。
