Mailander L, Lavie C J, Milani R V, Gaudin D
Department of Internal Medicine, Ochsner Medical Institutions, New Orleans, La 70121.
South Med J. 1993 May;86(5):508-12. doi: 10.1097/00007611-199305000-00004.
Although numerous epidemiologic and lipid intervention studies clearly demonstrate the pivotal role of high-density lipoprotein cholesterol (HDL-C) on risk of coronary artery disease (CAD), the National Cholesterol Education Program (NCEP) has emphasized only total cholesterol and low-density lipoprotein cholesterol (LDL-C), and has underemphasized the role of HDL-C in their lipid assessment and treatment recommendations. In a review of 113 consecutive patients in our cardiac rehabilitation program, lipid levels improved modestly with cardiac rehabilitation. "Ideal" lipids (LDL-C < 130 mg/dL according to the NCEP) were present in 49% before the rehabilitation program and in 46% afterward. In fact, 60 (53%) of our patients had total cholesterol levels < 200 mg/dL and would require no further lipid assessment or treatment according to the NCEP. Of these 60 patients, 40 (67%) had low HDL-C (< or = 35 mg/dL). In our total study group, 56% (63/113) had HDL-C < or = 35 mg/dL and 33% (37/113) had HDL-C < or = 30 mg/dL before rehabilitation (compared to 42% and 21%, respectively, after rehabilitation. On the other hand, a "high-risk" LDL-C value (> or = 160 mg/dL) was found in only 17% of patients at baseline and in only 13% after the cardiac rehabilitation program. Using an approach that incorporates the pivotal role of both LDL-C and HDL-C (LDL-C > or = 160 mg/dL or HDL-C < or = 35 mg/dL) for our patients with known CAD, 65% would require drug treatment before rehabilitation and 53% after rehabilitation. We conclude that: (1) lipids improve only modestly (though the change is significant statistically) with cardiac rehabilitation; (2) low levels of HDL-C are prevalent in cardiac rehabilitation patients and are much more prevalent than elevated LDL-C, both before and after rehabilitation; and (3) the NCEP should reevaluate the pivotal role of HDL-C in its assessment and treatment guidelines, particularly in patients with known CAD, since emphasis on both LDL-C and HDL-C is needed for optimal primary and secondary prevention of CAD.
尽管众多流行病学和血脂干预研究清楚地表明高密度脂蛋白胆固醇（HDL-C）在冠状动脉疾病（CAD）风险中起关键作用，但美国国家胆固醇教育计划（NCEP）仅强调了总胆固醇和低密度脂蛋白胆固醇（LDL-C），而在其血脂评估和治疗建议中对HDL-C的作用强调不足。在对我们心脏康复项目中连续113例患者的回顾中，血脂水平通过心脏康复有适度改善。“理想”血脂水平（根据NCEP，LDL-C < 130 mg/dL）在康复项目前有49%的患者存在，康复后为46%。事实上，我们60例（53%）患者的总胆固醇水平 < 200 mg/dL，根据NCEP不需要进一步的血脂评估或治疗。在这60例患者中，40例（67%）HDL-C水平低（≤ 35 mg/dL）。在我们的整个研究组中，康复前56%（63/113）患者的HDL-C ≤ 35 mg/dL，33%（37/113）患者的HDL-C ≤ 30 mg/dL（康复后分别为42%和21%）。另一方面，“高危”LDL-C值（≥ 160 mg/dL）在基线时仅在17%的患者中发现，心脏康复项目后仅为13%。对于我们已知患有CAD的患者，采用一种兼顾LDL-C和HDL-C关键作用的方法（LDL-C ≥ 160 mg/dL或HDL-C ≤ 35 mg/dL），康复前65%的患者需要药物治疗，康复后为53%。我们得出结论：（1）心脏康复后血脂仅适度改善（尽管变化在统计学上有显著意义）；（2）HDL-C水平低在心脏康复患者中普遍存在，且在康复前后都比LDL-C升高更为普遍；（3）NCEP应该重新评估HDL-C在其评估和治疗指南中的关键作用，特别是在已知患有CAD的患者中，因为对LDL-C和HDL-C都给予重视对于CAD的最佳一级和二级预防是必要的。
