Levy R I
Am J Cardiol. 1986 May 30;57(14):17G-26G. doi: 10.1016/0002-9149(86)90661-2.
Today the question is no longer whether cholesterol reduction is beneficial for those at risk for coronary artery disease; the questions now are when, whom and how to treat. Areas of great interest include extrapolation of current trial results to low density lipoprotein reduction by diet and drugs, and assessment of the value of increasing high density lipoprotein levels by pharmacologic means. We will need to decide what measurements (total cholesterol, lipoprotein cholesterol or lipoprotein apoprotein levels) are of most value to the diagnosis, treatment and follow-up of the at-risk patient. Recommendations, including those of the recently published National Institutes of Health Consensus Panel on Cholesterol Lowering, suggest that our index for diagnosis and treatment should be set considerably lower than it is today. To be successful with a more aggressive approach to cholesterol lowering, we will need to better support, educate and motivate the at-risk patient. Physicians need to become more knowledgeable about what plasma cholesterol is and how to change it. Methods that enhance patient adherence to diet and drug therapy must be developed. We will need to alter lifetime habits and will need the help of both the food industry and better informed consumers, knowledgeable on how to read food labels, if we are to succeed. Ultimately, we will need a 2-pronged approach, focusing on both the physician and the public at large.
如今，问题已不再是降低胆固醇对冠状动脉疾病高危人群是否有益；现在的问题是何时治疗、治疗谁以及如何治疗。备受关注的领域包括将当前试验结果外推至通过饮食和药物降低低密度脂蛋白，以及评估通过药物手段提高高密度脂蛋白水平的价值。我们需要确定哪些测量指标（总胆固醇、脂蛋白胆固醇或脂蛋白载脂蛋白水平）对高危患者的诊断、治疗和随访最有价值。包括最近发表的美国国立卫生研究院胆固醇降低共识小组的建议在内，都表明我们的诊断和治疗指标应设定得比目前低得多。为了更积极地降低胆固醇取得成功，我们需要更好地支持、教育和激励高危患者。医生需要对血浆胆固醇是什么以及如何改变它有更多的了解。必须开发出提高患者对饮食和药物治疗依从性的方法。如果我们要成功，就需要改变终身习惯，并且需要食品行业和更明智的消费者的帮助，这些消费者要知道如何阅读食品标签。最终，我们需要一种双管齐下的方法，既要关注医生，也要关注广大公众。
