Goldman L
Consolidated Department of Medicine, Brigham and Women's Hospital, Boston, MA.
Am Heart J. 1990 Mar;119(3 Pt 2):733-9; discussion 739-40. doi: 10.1016/s0002-8703(05)80054-7.
In the United States there has been a dramatic decrease in age-adjusted coronary heart disease (CHD) mortality during the last 20 years. This article investigates the reasons for this decline and concludes that most of the decline in CHD has been the result of life-style changes, particularly reduction in serum cholesterol and cigarette smoking. The CHD Policy Model is used to compare the effect of a targeted versus a population-wide program of cholesterol reduction. On the basis of these projections, population-wide interventions are considered an important part of cholesterol reduction programs. The article also assesses the cost-effectiveness of selected cardiac interventions, for example, screening exercise tolerance tests, coronary care units, thrombolysis in acute myocardial infarction, and beta-blockers in patients after myocardial infarction. Cost-effectiveness analysis is seen to be crucial as medical costs escalate and the population at risk from CHD increases.
在美国，过去20年中年龄调整后的冠心病（CHD）死亡率显著下降。本文探讨了这一下降的原因，并得出结论：冠心病死亡率的下降主要是生活方式改变的结果，特别是血清胆固醇降低和吸烟减少。冠心病政策模型用于比较针对性降胆固醇计划与全民降胆固醇计划的效果。基于这些预测，全民干预被视为降胆固醇计划的重要组成部分。本文还评估了所选心脏干预措施的成本效益，例如筛查运动耐量测试、冠心病监护病房、急性心肌梗死溶栓治疗以及心肌梗死后患者使用β受体阻滞剂。随着医疗成本的上升以及冠心病高危人群的增加，成本效益分析被认为至关重要。
