Grundy S M
Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas 75235-9052.
JAMA. 1990 Dec 19;264(23):3053-9.
The importance of high serum cholesterol levels as a risk factor for coronary heart disease and the benefit of lowering cholesterol levels for reducing risk are being increasingly accepted. A broad consensus to this effect has led to the establishment of the National Cholesterol Education Program. Although the available evidence fully justifies this program, its practical application to the American public has generated a series of new questions that must be explored. For example, it can be questioned whether reduction in coronary risk through lowering cholesterol levels extends to both sexes and all age groups. For people with high cholesterol levels, dietary modification is undoubtedly the first step of management, but the fraction of people responding adequately to dietary change remains to be determined. Finally, indications for drug therapy and choice of drugs need further exploration, particularly in the area of cost vs benefit. Thus, continuing research must be carried out in parallel with clinical and public health application of cholesterol education.
高血清胆固醇水平作为冠心病危险因素的重要性以及降低胆固醇水平以降低风险的益处正越来越被人们所接受。对此达成的广泛共识促成了国家胆固醇教育计划的设立。尽管现有证据充分证明了该计划的合理性，但其在美国公众中的实际应用引发了一系列必须加以探讨的新问题。例如，通过降低胆固醇水平来降低冠心病风险是否适用于所有性别和所有年龄组就值得质疑。对于胆固醇水平高的人来说，饮食调整无疑是管理的第一步，但对饮食变化有充分反应的人群比例仍有待确定。最后，药物治疗的指征和药物选择需要进一步探索，尤其是在成本与效益方面。因此，在进行胆固醇教育的临床和公共卫生应用的同时，必须开展持续的研究。
