Cleeman J I
National Cholesterol Education Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
Endocrinol Metab Clin North Am. 1998 Sep;27(3):597-611, ix. doi: 10.1016/s0889-8529(05)70028-1.
The National Cholesterol Education Program Adult Treatment Panel II guidelines recommend that all adults 20 years of age and older undergo testing to detect dyslipoproteinemia. Clinical trials have proven conclusively that lowering levels of low-density lipoprotein (LDL) cholesterol reduces coronary heart disease (CHD) incidence and mortality and total mortality in patients with and without CHD. There is persuasive scientific evidence to include young adults, women, and the elderly in the recommendation for cholesterol management. In adult without CHD, testing can begin with measurement of total cholesterol (TC) and high-density lipoprotein (HDL) cholesterol in the nonfasting state, and the results can then be used to determine which individuals require a fasting lipoprotein analysis (total cholesterol, HDL, triglycerides, and estimation of LDL); patients with known CHD should begin with lipoprotein analysis. The level of LDL cholesterol and the presence or absence of other CHD risk factors determine the need for cholesterol-lowering therapy. Patients with known CHD are at highest risk for a CHD event and have the lowest LDL cholesterol goal (100 mg/dL); patients without CHD but with elevated LDL-C (130 mg/dL) and two or more other CHD risk factors are at high risk for developing CHD and have an LDL cholesterol goal of less than 130 mg/dL; patients free of CHD with high LDL cholesterol (160 mg/dL) but fewer than two other risk factors have a lower CHD risk and an LDL cholesterol goal of less than 160 mg/dL. Elevated triglyceride may be a marker for other factors that increase CHD risk. Raising HDL cholesterol, while not proven to be of benefit, is reasonable in patients at high CHD risk.
美国国家胆固醇教育计划成人治疗专家组第二次报告指南建议，所有20岁及以上的成年人都应接受检测，以发现血脂蛋白异常。临床试验已确凿证明，降低低密度脂蛋白（LDL）胆固醇水平可降低冠心病（CHD）的发病率和死亡率以及患有和未患有冠心病患者的总死亡率。有确凿的科学证据表明，胆固醇管理建议应涵盖年轻人、女性和老年人。对于无冠心病的成年人，检测可从非空腹状态下测量总胆固醇（TC）和高密度脂蛋白（HDL）胆固醇开始，然后将结果用于确定哪些个体需要进行空腹血脂分析（总胆固醇、HDL、甘油三酯和LDL估算值）；已知患有冠心病的患者应从血脂分析开始。LDL胆固醇水平以及是否存在其他冠心病危险因素决定了是否需要进行降胆固醇治疗。已知患有冠心病的患者发生冠心病事件的风险最高，其LDL胆固醇目标最低（100mg/dL）；无冠心病但LDL-C升高（130mg/dL）且有两个或更多其他冠心病危险因素的患者发生冠心病的风险很高，其LDL胆固醇目标小于130mg/dL；无冠心病但LDL胆固醇高（160mg/dL）且其他危险因素少于两个的患者患冠心病的风险较低，其LDL胆固醇目标小于160mg/dL。甘油三酯升高可能是增加冠心病风险的其他因素的一个标志。提高HDL胆固醇虽未被证明有益，但对于冠心病高风险患者来说是合理的。
