Merz C N, Rozanski A, Forrester J S
Department of Medicine, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
Am J Med. 1997 Jun;102(6):572-81. doi: 10.1016/s0002-9343(97)00046-6.
Randomized clinical trials demonstrate the efficacy of medical secondary prevention in coronary disease patients. The magnitude of risk reduction with exercise, diet, lipid modification, and smoking cessation is similar to other medical therapies for coronary disease such as aspirin, beta blockers, as well as coronary bypass surgery, (Table VI) In contrast to these therapies, however, secondary prevention stabilizes angiographic progression in about 50% of patients and induces regression in about 25% of patients. Both symptoms and perceived quality of life also are beneficially altered by secondary prevention programs, although possibly not by the magnitude reported for bypass surgery. These clinical trial results have led the American Heart Association, and the American College of Cardiology to strongly endorse secondary prevention. A reasonable projection based on these clinical trial data is that widespread use of these recommendations in the 12 million established coronary disease patients would significantly reduce coronary mortality and morbidity.
随机临床试验证明了二级预防措施在冠心病患者中的有效性。运动、饮食、血脂调节和戒烟等措施降低风险的程度，与其他治疗冠心病的药物疗法（如阿司匹林、β受体阻滞剂）以及冠状动脉搭桥手术相似（表六）。然而，与这些疗法不同的是，二级预防措施能使约50%的患者血管造影进展稳定，并使约25%的患者血管造影表现出现逆转。二级预防项目也能对症状和感知到的生活质量产生有益的改变，尽管可能不如冠状动脉搭桥手术所报告的程度那么大。这些临床试验结果促使美国心脏协会和美国心脏病学会大力支持二级预防。基于这些临床试验数据的合理推测是，在1200万确诊的冠心病患者中广泛应用这些建议，将显著降低冠心病的死亡率和发病率。
