Hughes K
Department of Community, Occupational and Family Medicine, National University of Singapore, Singapore.
Ann Acad Med Singap. 1997 Mar;26(2):215-20.
The screening for and treatment of hypercholesterolaemia is still a complex and controversial issue. As hypercholesterolaemia is a major risk factor for coronary heart disease (CHD), there was initially much enthusiasm for mass screening with intervention recommended for persons with serum cholesterol levels > or = 6.5 mmol/L. However, trials of treatment of hypercholesterolaemia using lipid lowering drugs showed overall benefit (i.e. reduced all-cause mortality) only for persons with pre-existing CHD (secondary prevention) or other major risk factors. For this and other reasons (e.g. cost effectiveness) screening for hypercholesterolaemia has been recommended for persons with CHD or major risk factors (family history of premature coronary heart disease, cigarette smoking, hypertension, and diabetes mellitus). Recent trials with statins have shown greater benefit than with other lipid lowering drugs, confirming the benefits of secondary prevention. In addition, one trial has shown overall benefit after 5 years for middle-aged hypercholesterolaemic males without a previous myocardial infarction, raising the possibility of mass screening. However, longer follow-up of a number of trials of primary prevention including on persons without risk factors together with a full assessment of the local situation with regards to hypercholesterolaemia is needed before mass screening can be recommended.
高胆固醇血症的筛查和治疗仍是一个复杂且具争议性的问题。由于高胆固醇血症是冠心病（CHD）的主要危险因素，最初人们对大规模筛查热情高涨，并建议对血清胆固醇水平≥6.5 mmol/L的人群进行干预。然而，使用降脂药物治疗高胆固醇血症的试验表明，仅对已有冠心病（二级预防）或其他主要危险因素的人群有总体益处（即降低全因死亡率）。出于这个及其他原因（如成本效益），建议对患有冠心病或主要危险因素（早发性冠心病家族史、吸烟、高血压和糖尿病）的人群进行高胆固醇血症筛查。近期使用他汀类药物的试验显示出比其他降脂药物更大的益处，证实了二级预防的好处。此外，一项试验表明，对于既往无心肌梗死的中年高胆固醇血症男性，5年后有总体益处，这增加了大规模筛查的可能性。然而，在推荐大规模筛查之前，需要对包括无危险因素人群在内的多项一级预防试验进行更长时间的随访，并全面评估当地高胆固醇血症的情况。
