Jacobson T A, Schein J R, Williamson A, Ballantyne C M
Department of Medicine, Emory University, Atlanta, GA 30303, USA.
Arch Intern Med. 1998 Oct 12;158(18):1977-89. doi: 10.1001/archinte.158.18.1977.
Cardiovascular disease, including coronary heart disease, is the leading cause of death both in men and in women in the United States. The purpose of this review is to describe the effectiveness of lipid-lowering therapy in reducing cardiovascular morbidity and mortality, which has recently been extended to patients with mild to moderate hypercholesterolemia, and the cost of providing therapy, which would be prohibitive if all persons with hypercholesterolemia received treatment. Cost-effectiveness analysis provides a rational means of allocating limited health care resources by allowing the comparison of the costs of lipid-lowering therapy, in particular, therapy with beta-hydroxy-beta-methylglutaryl-CoA (coenzyme A) reductase inhibitors (statins), with the costs of atherosclerosis that could be prevented by lowering cholesterol. To extend the benefits of treatment to the large number of persons not receiving therapy, we need to implement more cost-effective treatment by improving risk assessment, increasing treatment effectiveness, and reducing the cost of therapy.
心血管疾病，包括冠心病，是美国男性和女性的首要死因。本综述的目的是描述降脂治疗在降低心血管发病率和死亡率方面的有效性（这种有效性最近已扩展至轻度至中度高胆固醇血症患者），以及提供治疗的成本（如果所有高胆固醇血症患者都接受治疗，成本将高得令人望而却步）。成本效益分析通过比较降脂治疗（特别是使用β-羟基-β-甲基戊二酰辅酶A还原酶抑制剂（他汀类药物）进行的治疗）的成本与降低胆固醇可预防的动脉粥样硬化的成本，提供了一种合理分配有限医疗资源的方法。为了将治疗的益处扩展到大量未接受治疗的人群，我们需要通过改进风险评估、提高治疗效果和降低治疗成本来实施更具成本效益的治疗。
