Castelli W P
Framingham Cardiovascular Institute, Massachusetts, USA.
Am J Cardiol. 1998 Nov 26;82(10B):60T-65T. doi: 10.1016/s0002-9149(98)00729-2.
Our understanding of coronary artery disease risk and the atherosclerotic process has changed greatly in recent years. For example, it is now known that angiographically apparent coronary artery plaque is not the major cause of myocardial infarction (MI). Rather, it is unstable, soft plaque that cannot be seen angiographically that is prone to rupture and result in infarction. Also important are changes in vascular reactivity resulting from diet. Cholesterol levels by themselves reveal little about a patient's coronary artery disease risk. Most infarctions occur in patients who have normal total cholesterol levels. At-risk patients can be identified using the ratio of total-to-high-density lipoprotein (HDL) cholesterol levels. The ratio of triglyceride to HDL cholesterol levels is also important. Simple steps to assess patients' risk in practice are outlined. Primary prevention trials demonstrate that coronary artery disease risk can be lowered dramatically with diet and drug therapy.
近年来，我们对冠状动脉疾病风险和动脉粥样硬化过程的理解发生了很大变化。例如，现在已知血管造影显示的冠状动脉斑块并非心肌梗死（MI）的主要原因。相反，是血管造影无法看到的不稳定软斑块易于破裂并导致梗死。饮食引起的血管反应性变化也很重要。胆固醇水平本身几乎无法揭示患者患冠状动脉疾病的风险。大多数梗死发生在总胆固醇水平正常的患者中。可以使用总胆固醇与高密度脂蛋白（HDL）胆固醇水平的比值来识别高危患者。甘油三酯与HDL胆固醇水平的比值也很重要。文中概述了在实践中评估患者风险的简单步骤。一级预防试验表明，通过饮食和药物治疗可以显著降低冠状动脉疾病风险。
