Unwin N, Thomson R, O'Byrne A M, Laker M, Armstrong H
Department of Medicine, University of Newcastle, Medical School, Newcastle NE2 4HH.
BMJ. 1998 Oct 24;317(7166):1125-30. doi: 10.1136/bmj.317.7166.1125.
To compare the implications of four widely used cholesterol screening and treatment guidelines by applying them to a population in the United Kingdom.
Guidelines were applied to population based data from a cross sectional study of cardiovascular disease and risk factors.
Newcastle upon Tyne, United Kingdom.
General population sample (predominantly of European origin) of 322 men and 319 women aged 25-64 years.
Proportions recommended for screening and treatment.
Criteria from the British Hyperlipidaemia Association, the British Drugs and Therapeutics Bulletin (which used the Sheffield table), the European Atherosclerosis Society, and the American national cholesterol education programme were applied to the population.
Proportions recommended for treatment varied appreciably. Based on the British Drugs and Therapeutics Bulletin guidelines, treatment was recommended for 5.3% (95% confidence interval 2.9% to 7.7%) of men and 3.3% (1.5% to 5.3%) of women, while equivalent respective values were 4.6 (2.3 to 6.9) and 2.8 (1.0 to 4.6) for the British Hyperlipidaemia Association, 23% (18.4% to 27.6%) and 10.6% (7.3% to 14.0%) for the European Atherosclerosis Society, and 37.2% (31.9% to 42.5%) and 22.2% (17.6% to 26.8%) for the national cholesterol education programme. Only the British Hyperlipidaemia Association and Drugs and Therapeutics Bulletin guidelines recommend selective screening. Applying British Hyperlipidaemia Association guidelines, from 7.1% (4.3% to 9.9%) of men in level one to 56.7% (51.3% to 62.1%) of men in level three, and from 4.4% (2.1% to 6.7%) of women in level one to 54.4% (48.9% to 59.9%) of women in level three would have been recommended for cholesterol screening. Had the Drugs and Therapeutics Bulletin guidelines been applied, 22.2% (16.5% to 27.9%) of men and 12.2% (8. 6% to 15.8%) of women would have been screened.
Without evidence based guidelines, there are problems of variation. A consistent approach needs to be developed and agreed across the United Kingdom.
通过将四种广泛使用的胆固醇筛查与治疗指南应用于英国人群，比较它们的影响。
将指南应用于基于心血管疾病及危险因素横断面研究的人群数据。
英国泰恩河畔纽卡斯尔。
年龄在25 - 64岁之间的322名男性和319名女性的普通人群样本（主要为欧洲血统）。
推荐进行筛查和治疗的比例。
将英国高脂血症协会、英国药物与治疗公报（使用谢菲尔德表格）、欧洲动脉粥样硬化学会以及美国国家胆固醇教育计划的标准应用于该人群。
推荐进行治疗的比例差异显著。根据英国药物与治疗公报的指南，推荐对5.3%（95%置信区间2.9%至7.7%）的男性和3.3%（1.5%至5.3%）的女性进行治疗，而英国高脂血症协会的相应比例分别为4.6%（2.3%至6.9%）和2.8%（1.0%至4.6%），欧洲动脉粥样硬化学会为23%（18.4%至27.6%）和10.6%（7.3%至14.0%），美国国家胆固醇教育计划为37.2%（31.9%至42.5%）和22.2%（17.6%至26.8%）。只有英国高脂血症协会和药物与治疗公报的指南推荐进行选择性筛查。应用英国高脂血症协会的指南，一级男性中7.1%（4.3%至9.9%）至三级男性中56.7%（51.3%至62.1%），以及一级女性中4.4%（2.1%至6.7%）至三级女性中54.4%（48.9%至59.9%）的人群会被推荐进行胆固醇筛查。若应用药物与治疗公报的指南，22.2%（16.5%至27.9%）的男性和12.2%（8.6%至15.8%）的女性会接受筛查。
缺乏循证指南会导致差异问题。英国需要制定并达成一种一致的方法。
