Ives D G, Kuller L H, Traven N D
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA 15261.
Am J Prev Med. 1993 Sep-Oct;9(5):274-81.
Few studies have evaluated the efficacy of cholesterol-lowering interventions in a community setting and have included a control or comparison group. As part of a preventive health demonstration project in rural Pennsylvania, Medicare beneficiaries underwent cholesterol screening to identify high-risk individuals with serum cholesterol levels > or = 240 mg/dL. These high-risk individuals were randomized to a cholesterol-lowering intervention through either local hospitals or physicians' offices or to a control group. Baseline and follow-up serum cholesterol levels collected two to three years later were compared according to service location (hospital versus physician's office), intervention attendance, degree of participation, baseline heart disease history, and cholesterol-lowering medication use at follow-up. Serum cholesterol levels decreased between 5.7% and 6.6% in the hospital-based and physician-based groups, as well as in a control group not offered the intervention. Participation rates did not differ between treatment groups, nor did participation affect serum cholesterol levels. Attendance level and heart disease history were not associated with a greater decrease in serum cholesterol levels. Individuals reporting cholesterol-lowering drug use at follow-up had significantly higher baseline serum cholesterol levels and a significantly greater decrease in total serum cholesterol (P < .0001) than those not on medication. Both nonpharmacological (diet) and pharmacological (drug) interventions will reduce serum cholesterol levels and heart attack risk. The study results suggest that, at least for older individuals, the impact of nonpharmacological interventions on the community is minimal. We conclude that only very aggressive treatment will significantly loser serum cholesterol levels in older individuals at risk for heart attack.
很少有研究在社区环境中评估降胆固醇干预措施的疗效，并且这些研究还纳入了对照组或比较组。作为宾夕法尼亚州农村地区一项预防性健康示范项目的一部分，医疗保险受益人接受了胆固醇筛查，以识别血清胆固醇水平≥240mg/dL的高危个体。这些高危个体被随机分配至通过当地医院或医生办公室进行的降胆固醇干预组或对照组。对两到三年后收集的基线和随访血清胆固醇水平，根据服务地点（医院与医生办公室）、干预参与情况、参与程度、基线心脏病史以及随访时使用降胆固醇药物的情况进行比较。在以医院为基础的组、以医生为基础的组以及未接受干预的对照组中，血清胆固醇水平下降了5.7%至6.6%。各治疗组之间的参与率没有差异，参与情况也未影响血清胆固醇水平。参与程度和心脏病史与血清胆固醇水平的更大降幅无关。在随访时报告使用降胆固醇药物的个体，其基线血清胆固醇水平显著更高，总血清胆固醇的降幅也显著更大（P<.0001），高于未使用药物的个体。非药物（饮食）和药物（药物）干预均可降低血清胆固醇水平和心脏病发作风险。研究结果表明，至少对于老年人而言，非药物干预对社区的影响微乎其微。我们得出结论，只有非常积极的治疗才能显著降低有心脏病发作风险的老年人的血清胆固醇水平。
