Esposito Katherine, Ceriello Antonio, Genovese Stefano, Giugliano Dario
Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy.
Cardiovasc Diabetol. 2014 Mar 28;13:66. doi: 10.1186/1475-2840-13-66.
The release of recent guidelines for high cholesterol, hypertension and diabetes in the U.S. has been accompanied by great noise and concerns, both in the academic circuits and the lay press. For persons aged 40 to 75 years, with LDL cholesterol levels between 70-189 mg/dL and 7.5% or higher estimated 10-year risk, the peril of a global "statinization" has been advocated, predicting a 70% increase of statin use in this otherwise healthy people. A minority of the Eight Joint National Committee panel disagreed with the recommendation to increase the target systolic blood pressure from 140 to 150 mmHg in persons aged 60 years or older without diabetes mellitus or chronic kidney disease. The 2013-American Association of Clinical Endocrinologists algorithm and consensus statement on diabetes has been criticized with particular concerns about transparency, conflicts of interest, group composition, and the abundant use of personal judgment and experience instead of rigorous methodology. Separate careers for experts who collect evidence from persons who write the actual guidelines seems a good opportunity in order to attenuate the noise associated with release of new guidelines, especially those that counter prior practice.
美国近期发布的高胆固醇、高血压和糖尿病指南引发了学术界和大众媒体的广泛关注与热议。对于年龄在40至75岁之间、低密度脂蛋白胆固醇水平在70 - 189毫克/分升且估计10年风险为7.5%或更高的人群，有人主张全球“他汀类药物化”的风险，预计在这些原本健康的人群中他汀类药物的使用将增加70%。美国国家联合委员会八名成员中有少数人不同意将60岁及以上无糖尿病或慢性肾病患者的收缩压目标从140毫米汞柱提高到150毫米汞柱的建议。2013年美国临床内分泌医师协会关于糖尿病的算法和共识声明受到了批评，尤其涉及透明度、利益冲突、小组构成，以及大量使用个人判断和经验而非严谨方法等问题。让收集证据的专家与撰写实际指南的人员分开工作，似乎是减少与新指南发布相关噪音的一个好机会，特别是那些与先前做法相悖的指南。
