Ceska R
III. interní klinika, 1. LF UK a VFN Praha.
Vnitr Lek. 1996 Aug;42(8):568-72.
There are sufficient arguments for treatment of hyperlipoproteinaemia at present and this treatment is considered not only rational but also an essential procedure in primary and in particular in secondary prevention of cardiovascular diseases. Views of scepticists as regards this treatment are, with regard to the most recent epidemiological studies with hypolipidaemic agents, not very convincing and the majority is refused. Treatment of patients with hyperlipoproteinaemia is comprehensive, its basis being dietary and lifestyle measures. The latter are, if they are not sufficiently effective, with increasing frequency supplemented with medicamentous intervention. This treatment is then as a rule very effective and leads to rapid achievement of desirable "target values" of parameters of lipid and lipoprotein metabolism. This comprehensive therapeutic algorithm is considered the modern approach to primary and secondary prevention of cardiovascular diseases. If a long-term favourable effect on the lipid spectrum is to be achieved in individual subjects and whole populations (and in particular in populations of subjects with the highest risk of manifestation of complications of atherosclerosis), it is essential to implement the mentioned therapeutic measures on a long-term basis, frequently for the rest of life. Considering contemporary prices of medicaments which are used to influence risk factors of atherosclerosis, this quite understandably worries health economists. Despite their "economic" objections it is important to give maximal support to preventive measures. Therapeutic procedures in advanced disease may be finally incomparably more expensive than soundly implemented preventive measures. On the other hand, it is a must to treat disorders of the lipid metabolism, as well as other risk factors of atherosclerosis such as hypertension or diabetes mellitus rationally, respecting recent results of basic and applied research. It is also a great advantage if we can use as a basis for the diagnostic and therapeutic algorithm international widely accepted recommendations of European and American societies. We also use their recommendations as guidelines when seeking the right patient or group of subjects on whom our greatest therapeutic effort should be focused.
目前，对于高脂蛋白血症的治疗有充分的论据，这种治疗不仅被认为是合理的，而且是心血管疾病一级预防尤其是二级预防中的必要措施。就降脂药物的最新流行病学研究而言，怀疑论者对此治疗的观点并不十分令人信服，且大多被否定。高脂蛋白血症患者的治疗是综合性的，其基础是饮食和生活方式措施。如果这些措施效果不充分，越来越多地会辅以药物干预。这种治疗通常非常有效，并能迅速达到脂质和脂蛋白代谢参数的理想“目标值”。这种综合治疗方案被认为是心血管疾病一级和二级预防的现代方法。要在个体和整个人群中（尤其是在动脉粥样硬化并发症表现风险最高的人群中）实现对血脂谱的长期有利影响，必须长期实施上述治疗措施，通常要持续一生。考虑到用于影响动脉粥样硬化危险因素的药物的当代价格，这理所当然地令卫生经济学家担忧。尽管他们有“经济”方面的反对意见，但对预防措施给予最大支持很重要。晚期疾病的治疗程序最终可能比合理实施的预防措施昂贵得多。另一方面，必须合理治疗脂质代谢紊乱以及动脉粥样硬化的其他危险因素，如高血压或糖尿病，同时要考虑基础研究和应用研究的最新结果。如果我们能以欧美社会国际广泛接受的建议作为诊断和治疗方案的基础，那也是一大优势。在寻找最应集中最大治疗精力的合适患者或患者群体时，我们也将他们的建议用作指导方针。
