Hulley S B, Rosenman R H, Bawol R D, Brand R J
N Engl J Med. 1980 Jun 19;302(25):1383-9. doi: 10.1056/NEJM198006193022503.
The hypothesis that triglyceride is a cause of coronary heart disease, although unconfirmed and never universally accepted, has nonetheless strongly influenced the practice of preventive medicine. We have examined the epidemiologic association between triglyceride and coronary heart disease to evaluate the validity of inferring that there is a causal relation between the two. Neither the evidence from published studies nor an analysis of data from the Western Collaborative Group Study provides strong support for the causal hypothesis. Information from other scientific disciplines is also meager, contrasting with the coherence of diverse evidence supporting the hypothesis that cholesterol is a cause of coronary heart disease. These arguments fall short of disproving the belief that lowering triglyceride will prevent coronary heart disease, especially since triglyceride and cholesterol are inextricably associated through mutual lipoprotein carriers. But we propose that the ethics of preventive medicine place the burden of proof on the proponents of intervention. We therefore recommend that widespread screening and treatment of healthy persons for hypertriglyceridemia be abandoned until more persuasive evidence becomes available.
甘油三酯是冠心病病因的假说，尽管尚未得到证实且从未被普遍接受，但却对预防医学实践产生了重大影响。我们研究了甘油三酯与冠心病之间的流行病学关联，以评估推断两者之间存在因果关系的有效性。已发表研究的证据以及对西方协作组研究数据的分析，均未为因果假说提供有力支持。来自其他科学学科的信息也很匮乏，这与支持胆固醇是冠心病病因假说的各种证据的一致性形成了对比。这些论据不足以推翻降低甘油三酯可预防冠心病的观点，特别是因为甘油三酯和胆固醇通过共同的脂蛋白载体紧密相连。但我们认为，预防医学的伦理要求应由干预措施的支持者承担举证责任。因此，我们建议在获得更有说服力的证据之前，放弃对健康人群进行广泛的高甘油三酯血症筛查和治疗。
