Epstein F H
Atherosclerosis. 1977 Apr;26(4):515-23. doi: 10.1016/0021-9150(77)90119-8.
Is the relationship between coronary heart disease risk factors and the risk of disease causal? Direct evidence would have to come, of necessity, from preventive trials. However, the difficult nature of such trials carries the inherent danger of false negative results; even positive results may be open to challenge. With regard to demonstrating specifically a preventive effect of lowering serum lipid levels through nutritional changes alone, this evidence may never be forthcoming since ongoing trials intervene simultaneously on multiple factors; against this disadvantage, the strengths of such trials are reviewed. The view is stated and discussed that preventive action in the community is justified now, without waiting for the results of preventive trials, however important they will be eventually to help the development of optimally effective programs.
冠心病风险因素与疾病风险之间的关系是因果关系吗？直接证据必然要来自预防性试验。然而，此类试验的困难性质存在得出假阴性结果的固有风险；即使是阳性结果也可能受到质疑。关于仅通过营养改变来具体证明降低血清脂质水平的预防效果，由于正在进行的试验同时对多个因素进行干预，可能永远无法获得这方面的证据；针对这一不利因素，本文对这类试验的优势进行了综述。文中提出并讨论了一种观点，即现在社区采取预防行动是合理的，无需等待预防性试验的结果，无论这些结果最终对于帮助制定最佳有效方案有多重要。
