Allen J K, Young D R, Blumenthal R S, Moy T F, Yanek L R, Wilder L, Becker L C, Becker D M
School of Nursing, Johns Hopkins University School of Medicine, Baltimore, Md, USA.
Arch Intern Med. 1996;156(15):1654-60.
Increased blood cholesterol, specifically high low-density lipoprotein cholesterol, increases risk for coronary heart disease (CHD). Persons with a positive family history of premature CHD also are at markedly increased risk.
To examine the prevalence of hypercholesterolemia based on the second report of the National Cholesterol Educational Program Adult Treatment Panel (ATP II) guidelines in the asymptomatic healthy siblings of people with premature CHD.
A total of 668 asymptomatic healthy siblings (354 men and 314 women) underwent screening for risk factors for CHD. Siblings were categorized into treatment categories for primary prevention defined by ATP II. The percentage who were candidates for intervention were compared with the published national estimates for those without CHD from the third National Health and Nutrition Examination Survey (NHANES III).
Based on ATP II guidelines, 65% of the asymptomatic adult siblings required fasting lipoprotein analysis compared with 33% of adults without CHD in the national reference population. Of the siblings who met the criteria for fasting lipoprotein analysis, most (56%) were candidates for dietary therapy, more than twice the proportion of adults from NHANES III. The percentage of the siblings who qualified for drug intervention and dietary therapy was 3 times greater than the national sample, 33% vs 11%, respectively. Assuming a 10% hypothetical reduction in low-density lipoprotein cholesterol levels as the result of dietary modification, the proportion of the sibling sample who were possible candidates for drug therapy was 20%, still 4 times that predicted for the national sample.
These results underscore the need for aggressive detection and treatment of hypercholesterolemia in this easily identifiable high-risk population of siblings of people with premature CHD.
血液胆固醇升高，尤其是低密度脂蛋白胆固醇水平升高，会增加冠心病（CHD）的发病风险。有早发性冠心病家族史的人患病风险也显著增加。
根据国家胆固醇教育计划成人治疗小组（ATP II）指南的第二次报告，研究早发性冠心病患者无症状健康兄弟姐妹中高胆固醇血症的患病率。
共有668名无症状健康兄弟姐妹（354名男性和314名女性）接受了冠心病危险因素筛查。根据ATP II将兄弟姐妹分为一级预防的治疗类别。将符合干预条件的百分比与第三次全国健康和营养检查调查（NHANES III）中公布的无冠心病人群的全国估计值进行比较。
根据ATP II指南，65%的无症状成年兄弟姐妹需要进行空腹脂蛋白分析，而全国参考人群中无冠心病的成年人这一比例为33%。在符合空腹脂蛋白分析标准的兄弟姐妹中，大多数（56%）符合饮食治疗条件，是NHANES III中成年人比例的两倍多。符合药物干预和饮食治疗条件的兄弟姐妹百分比分别比全国样本高3倍，即33%和11%。假设饮食调整使低密度脂蛋白胆固醇水平假设性降低10%，兄弟姐妹样本中可能符合药物治疗条件的比例为20%，仍是全国样本预测比例的4倍。
这些结果强调了在早发性冠心病患者这一易于识别的高风险兄弟姐妹人群中，积极检测和治疗高胆固醇血症的必要性。
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