Newman T B, Garber A M, Holtzman N A, Hulley S B
Department of Laboratory Medicine, School of Medicine, University of California-San Francisco.
Arch Pediatr Adolesc Med. 1995 Mar;149(3):241-7. doi: 10.1001/archpedi.1995.02170150021003.
An Expert Panel convened by the National Cholesterol Education Program has recommended selective screening and treatment of children for high blood cholesterol levels, based on family history of cardiovascular disease or high blood cholesterol. This recommendation is problematic for several reasons. First, the recommended diets are likely to cause only a slight decrease in low-density lipoprotein cholesterol levels, the projected benefits of which will be offset by a similar decrease in high-density lipoprotein cholesterol levels. Lack of efficacy of the recommended diets could lead to use of more restrictive diets or to cholesterol lowering drugs. Second, even under optimistic assumptions, beneficial effects of cholesterol intervention will be small and delayed for many decades. As a result, childhood cholesterol-lowering efforts will not be cost-effective. Third, the Expert Panel's recommendations do not address important gender differences. Girls have higher average cholesterol levels than boys. They will therefore qualify for more dietary and drug treatment despite their lower age-adjusted risk of heart disease and the lack of association between cholesterol levels and cardiovascular mortality in women. Finally, recent evidence from randomized trials, cohort studies, and animal experiments suggests that cholesterol lowering may have serious adverse effects. This evidence was not discussed in the Expert Panel's report. Given current evidence, any screening and treatment of children for high blood cholesterol levels is, at best, premature.
由国家胆固醇教育计划召集的一个专家小组建议，根据心血管疾病家族史或高血胆固醇水平，对儿童进行选择性筛查和高血胆固醇水平治疗。这一建议存在几个问题。首先，推荐的饮食可能只会使低密度脂蛋白胆固醇水平略有下降，而其预期益处将被高密度脂蛋白胆固醇水平的类似下降所抵消。推荐饮食缺乏疗效可能导致采用更严格的饮食或使用降胆固醇药物。其次，即使在乐观的假设下，胆固醇干预的有益效果也将很小，且会延迟数十年。因此，儿童降胆固醇的努力将不具有成本效益。第三，专家小组的建议没有考虑到重要的性别差异。女孩的平均胆固醇水平高于男孩。因此，尽管她们按年龄调整的心脏病风险较低，且胆固醇水平与女性心血管死亡率之间缺乏关联，但她们将有资格接受更多的饮食和药物治疗。最后，来自随机试验、队列研究和动物实验的最新证据表明，降低胆固醇可能有严重的不良反应。专家小组的报告中没有讨论这一证据。根据目前的证据，对儿童进行任何高血胆固醇水平的筛查和治疗，充其量都为时过早。
