Mach François, Riesen Walter F, Rodondi Nicolas, Von Eckardstein Arnold
Rev Med Suisse. 2014 Dec 17;10(455):2430-3.
Although lipid-lowering therapy in patients with established coronary heart disease (secondary prevention) is generally accepted, its benefit is often questioned in asympto- matic patients. The ongoing debate about the usefulness of statin therapy has disturbed many patients, especially in the French- and Italian-speaking parts of Switzerland, which lead too often to treatment discontinuation, even in patients who would benefit the most from it. In the primary prevention, the reduction in LDL cholesterol levels with statins decreases the risk for cardiovascular events. The higher the baseline risk, the greater the benefits in terms of absolute risk reduction; hence, using a scoring tool to evaluate the cardiovascular risk is needed. For patients at low risk, lifestyle interventions are preferable.
虽然在已确诊冠心病患者中进行降脂治疗（二级预防）已被普遍接受，但在无症状患者中其益处常常受到质疑。关于他汀类药物治疗有效性的持续争论困扰了许多患者，尤其是在瑞士讲法语和意大利语的地区，这常常导致治疗中断，即使是那些最能从中受益的患者。在一级预防中，使用他汀类药物降低低密度脂蛋白胆固醇水平可降低心血管事件风险。基线风险越高，绝对风险降低方面的益处就越大；因此，需要使用评分工具来评估心血管风险。对于低风险患者，生活方式干预更为可取。
