Gerdes L U, Bak A M, Faergeman O
Arhus Amtssygehus, medicinsk afdeling I.
Ugeskr Laeger. 1990 Jun 11;152(24):1747-52.
The prevalence of risk factors for ischaemic heart disease (IHD) was recorded in 1,365 men aged 20-59 years in active employment. The purpose was to evaluate the implications of a high-risk strategy based on the rather conservative Danish guidelines for treatment of hypercholesterolemia. The prevalence of various risk factors depends on age, but in all, 1% had diabetes mellitus, 5% had a family history of premature IHD, 50% were smokers, 21% were obese, 12% had systolic blood pressure greater than or equal to 160 mmHg, 8% had diastolic blood pressure greater than or equal to 100 mmHg and 14% had serum cholesterol greater than 7 mmol/l. Only 24% had none of these risk factors and there was a considerable clustering of risk factors in certain subgroups. Approximately 34%, varying from 17% of the younger to 49% of the older, required medical follow-up as part of the high risk strategy. We have estimated the required number of visits to a general practitioner, if all Danish men aged 20-59 years were screened within three years and approximately 30% required follow-up for five years, with three visits in the first year and one thereafter. The number of visits peaks at 450 visits per year during the third year, and a number of circumstances could reduce this figure considerably. Multifactorial models to estimate risk in connection with screening should be adopted to the Danish guidelines for treatment of hypercholesterolemia and hypertension, and future guidelines for intervention should probably be integrated in such a multifactorial model. To practice preventive medicine, many physicians will need greater knowledge of dietary counselling.
对1365名年龄在20至59岁之间的在职男性记录了缺血性心脏病（IHD）危险因素的患病率。目的是评估基于丹麦较为保守的高胆固醇血症治疗指南的高风险策略的影响。各种危险因素的患病率取决于年龄，但总体而言，1%患有糖尿病，5%有IHD早发家族史，50%为吸烟者，21%肥胖，12%收缩压大于或等于160 mmHg，8%舒张压大于或等于100 mmHg，14%血清胆固醇大于7 mmol/l。只有24%没有这些危险因素，并且在某些亚组中危险因素有相当程度的聚集。作为高风险策略的一部分，约34%（年龄较小者为17%，年龄较大者为49%）需要医学随访。我们估计了如果三年内对所有20至59岁的丹麦男性进行筛查，约30%需要随访五年（第一年3次，此后每年1次）时，全科医生所需的就诊次数。就诊次数在第三年达到每年450次的峰值，并且一些情况可能会大幅降低这一数字。用于估计筛查相关风险的多因素模型应符合丹麦高胆固醇血症和高血压治疗指南，未来的干预指南可能应纳入这样的多因素模型。为了实施预防医学，许多医生将需要更多关于饮食咨询的知识。
