López-Sendón J L, Rubio R, López de Sá E, Delcán J L
Departamento de Cardiología, Hospital Universitario Gregorio Marañón, Madrid.
Rev Esp Cardiol. 1995;48 Suppl 2:23-32.
This review discuss the possible 10 top reasons why cardiologists are/should be interested in lipids. 1. Epidemiologic evidence. Blood lipid levels are risk factors for coronary heart disease and predict subsequent mortality in the patients seen by cardiologists. 2. Lipids play a major physiopathologic role in ischemic heart disease. Stenosis of the coronary arteries are produced by atherosclerotic plaques, composed of a mass of lipids covered by a fibrous cap. Plaques with increased lipid content appear more prone to rupture and cause acute coronary syndromes. 3. Lipid abnormalities are very common in patients with ischemic heart disease. At least half the patients with angiographic evidence of significant coronary artery narrowings have severe abnormalities of lipids that are easy (and cheap) to detect. 4. Reduction of cholesterol is associated with regression of atherosclerosis, as has been demonstrated by angiography in patients with coronary heart disease. 5. Reduction of cholesterol is associated with reduction of symptoms and ischemic events. 6. The most striking benefit of lipid lowering therapy is shown in patients, already with evidence of ischemic heart disease. 7. The new lipid lowering agents present a new profile of actions and may improve symptoms in the short term. 8. There is still controversy about who should be treated, when and with what drugs, and this questions will be solved with the evidence of large, multicenter, well designed trials that are now in progress. Cardiologists must contribute to this studies, know and discuss the results. 9. If a patient is not given by his cardiologist any drug to reduce the cholesterol it is quite improbable that other doctor would make such recommendation. 10. Even if the cardiologist is not interested in lipids their patients are, and seek and deserve advice.
本综述探讨了心脏病专家关注血脂的十大可能原因。1. 流行病学证据。血脂水平是冠心病的危险因素，可预测心脏病专家所诊治患者的后续死亡率。2. 血脂在缺血性心脏病中起主要病理生理作用。冠状动脉狭窄由动脉粥样硬化斑块引起，这些斑块由纤维帽覆盖的脂质团块组成。脂质含量增加的斑块似乎更容易破裂并导致急性冠状动脉综合征。3. 脂质异常在缺血性心脏病患者中非常常见。至少一半有冠状动脉造影显示明显狭窄的患者存在严重的脂质异常，且易于（且成本低廉）检测。4. 降低胆固醇与动脉粥样硬化的消退相关，这已在冠心病患者的血管造影中得到证实。5. 降低胆固醇与症状和缺血事件的减少相关。6. 降脂治疗最显著的益处体现在已有缺血性心脏病证据的患者中。7. 新型降脂药物呈现出新的作用特点，可能在短期内改善症状。8. 关于谁应该接受治疗、何时治疗以及使用何种药物仍存在争议，这些问题将通过目前正在进行的大型、多中心、精心设计的试验证据来解决。心脏病专家必须参与这些研究，了解并讨论研究结果。9. 如果心脏病专家未给患者开任何降低胆固醇的药物，其他医生很可能也不会给出这样的建议。10. 即使心脏病专家对血脂不感兴趣，他们的患者也感兴趣，并且寻求并理应得到相关建议。
