Haq I U, Jackson P R, Yeo W W, Ramsay L E
Department of Medicine and Pharmacology, Royal Hallamshire Hospital, Sheffield, UK.
Lancet. 1995 Dec 2;346(8988):1467-71. doi: 10.1016/s0140-6736(95)92477-9.
When used for the secondary prevention of coronary heart disease, treatment with an inhibitor of hydroxymethylglutaryl-coenzyme-A reductase results in worthwhile benefit that clearly exceeds any risk in patients whose risk of coronary death is 1.5% or more per year. This evidence can be extrapolated logically to primary prevention of coronary disease provided that treatment is targeted at those with similar or higher risk. We present a table that refines previously proposed methods of risk prediction. The table identifies subjects who have the specified degree of coronary risk; shows the serum cholesterol concentration that confers that degree or risk in the individual; and identifies subjects who will not have this degree of risk, irrespective of their cholesterol concentration. It is simple enough for use in ordinary practice. The table highlights the predominant effect of age on coronary risk; a person who is free of vascular disease and younger than 52 years is unlikely to have the specified degree of risk. Even in older people (60-70 years) several risk factors are generally required to attain this degree of risk. Some people are candidates for lipid- lowering drug treatment with serum cholesterol as low as 5.5 mmol/L, whereas others with cholesterol as high as 9.0 mmol/L are not. Although cholesterol lowering is a powerful method for preventing coronary events in people at high risk, cholesterol measurement by itself is not a good way to identify those with high coronary risk. The method can be adapted readily to target a different level of coronary risk as new evidence on the benefit and risk of treatment becomes available.
当用于冠心病的二级预防时，对于每年冠心病死亡风险为1.5%或更高的患者，使用羟甲基戊二酰辅酶A还原酶抑制剂进行治疗可带来显著益处，且明显超过任何风险。只要治疗针对具有相似或更高风险的人群，这一证据可合理外推至冠心病的一级预防。我们给出了一个表格，该表格完善了先前提出的风险预测方法。该表格可识别具有特定程度冠心病风险的受试者；显示赋予个体该程度风险的血清胆固醇浓度；并识别无论其胆固醇浓度如何都不会有该程度风险的受试者。它简单易用，可在日常实践中使用。该表格突出了年龄对冠心病风险的主要影响；没有血管疾病且年龄小于52岁的人不太可能有特定程度的风险。即使在老年人（60 - 70岁）中，通常也需要几个风险因素才会达到该程度的风险。一些人的血清胆固醇低至5.5 mmol/L就是降脂药物治疗的候选对象，而另一些人胆固醇高达9.0 mmol/L却不是。虽然降低胆固醇是预防高危人群发生冠心病事件的有力方法，但仅通过测量胆固醇本身并非识别冠心病高危人群的好方法。随着关于治疗益处和风险的新证据出现，该方法可轻松调整以针对不同水平的冠心病风险。
