Castelli W P
Arch Mal Coeur Vaiss. 1987 Apr;80 Spec No:11-5.
Although cardiovascular mortality has decreased in recent years, it is still largely due to coronary disease: 1 out of 5 men and 1 out of 17 women are affected by that disease before the age of 60. Among the risk factors involved are lipid disturbances, themselves divided into three factors: LDL-cholesterol, triglycerides and HDL-cholesterol. A plasma LDL-cholesterol level above 150 units is a high risk factor. Triglyceride levels higher than 1.50 g/l, associated with HDL levels lower than 40 mg/dl constitute a new entity, a genetic disease associated with a special fragment on chromosome 11, characterized by high risk low HDL levels (below 40). Another risk factor, even in elderly people, is arterial hypertension. Cigarette smoking, lack of physical activity, diabetes and mental stress remain important factors, whereas obesity has become a separate factor. Finally, such factors as ECG abnormalities, plasma uric acide or plasminogen levels, familial context, etc., may be taken into consideration. All dietetic and therapeutic measures aimed at lowering the cholesterol level show a 2-3 p. 100 fall in the incidence of coronary disease for each 1 p. 100 reduction of blood cholesterol. A new programme, similar to those used in screening for high blood pressure subjects, will be set up in the U.S.A. to identify people with a blood cholesterol level higher than 2.40 g/l, treat them and bring that figure down below 2.00 g/l. The management of arterial hypertension is still based on treatments which do not increase blood cholesterol or increase HDL. They include alpha-blockers, beta-2 agonists and blockers of intracellular contractility. They have the additional advantage of improving capillary perfusion.
尽管近年来心血管疾病死亡率有所下降，但很大程度上仍是由冠心病导致：每5名男性中有1人、每17名女性中有1人在60岁之前受该病影响。涉及的风险因素包括血脂紊乱，其本身又分为三个因素：低密度脂蛋白胆固醇、甘油三酯和高密度脂蛋白胆固醇。血浆低密度脂蛋白胆固醇水平高于150单位是高风险因素。甘油三酯水平高于1.50克/升，同时高密度脂蛋白水平低于40毫克/分升，构成一种新的情况，这是一种与11号染色体上一个特殊片段相关的遗传病，其特征是高风险、低高密度脂蛋白水平（低于40）。另一个风险因素，即使在老年人中，是动脉高血压。吸烟、缺乏体育活动、糖尿病和精神压力仍然是重要因素，而肥胖已成为一个单独的因素。最后，诸如心电图异常、血浆尿酸或纤溶酶原水平、家族背景等因素也可予以考虑。所有旨在降低胆固醇水平的饮食和治疗措施显示，血液胆固醇每降低1%，冠心病发病率下降2%至3%。美国将设立一个新的项目，类似于用于筛查高血压患者的项目，以识别血液胆固醇水平高于2.40克/升的人，对他们进行治疗并将该数值降至2.00克/升以下。动脉高血压的治疗仍基于不会增加血液胆固醇或能提高高密度脂蛋白的治疗方法。这些方法包括α受体阻滞剂、β2激动剂和细胞内收缩阻滞剂。它们还有改善毛细血管灌注的额外优势。
