Windler E, Beil F U
Medizinische Kernklinik und Poliklinik, Universitäts-Krankenhaus Eppendorf, Hamburg.
Herz. 1997 Jun;22(3):125-33. doi: 10.1007/BF03044349.
Coronary artery disease has still a grave prognosis. More than half the patients die within 24 hours, mostly before reaching a hospital. A minority survives the first year. Only more intense prevention will change this. Primary prevention in a narrow sense refers to the prevention of the development of early lesions in the youth and as such is a responsibility of the education towards a healthy lifestyle. In our population a majority of middle-aged is likely to have developed arteriosclerosis, so that we deal only with clinically defined primary prevention even though they are asymptomatic. The outstanding effects of lipid therapy in patients at risk for coronary heart disease will primarily result from avoiding the development of instable plaques. Reduction of LDL-cholesterol and increase of HDL-cholesterol is most effective in patients with proven coronary artery disease. Evidently the majority of coronary events can be prevented by idealizing the lipid parameters. In contrast, the chronic coronary syndrome is the domain of the interventional cardiology. Lipid therapy will lead only gradually to a reduction of significant coronary stenoses. However, there is the still insufficiently investigated potential of improving the endothelial dysfunction by correcting the lipid metabolism to reduce angina.
冠状动脉疾病的预后仍然很严峻。超过半数的患者在24小时内死亡，大多数是在到达医院之前。少数患者能活过第一年。只有更积极的预防措施才能改变这种状况。狭义的一级预防是指预防年轻人早期病变的发生，因此这是健康生活方式教育的责任。在我们的人群中，大多数中年人可能已经发生了动脉硬化，所以即使他们没有症状，我们处理的也只是临床定义的一级预防。脂质治疗对冠心病高危患者的显著效果主要源于避免不稳定斑块的形成。降低低密度脂蛋白胆固醇和升高高密度脂蛋白胆固醇对已确诊冠状动脉疾病的患者最为有效。显然，通过优化脂质参数可以预防大多数冠状动脉事件。相比之下，慢性冠状动脉综合征属于介入心脏病学的范畴。脂质治疗只会逐渐减少严重的冠状动脉狭窄。然而，通过纠正脂质代谢来改善内皮功能障碍以减轻心绞痛的潜力仍未得到充分研究。
