Prevention and treatment of coronary heart disease - Who benefits?
Prevention and treatment of coronary heart disease - Who benefits?
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DOI：
10.1161/hc3901.096665
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发表时间：
2001-10-02
期刊：
影响因子：
37.8
通讯作者：
LaRosa, JC
中科院分区：
文献类型：
--
作者：
LaRosa, JC
冠心病(CHID)仍然是美国发病率和死亡率的主要原因，尽管我们对动脉粥样硬化的病理生物学有了更好的了解，我们对风险因素的了解，廉价胆固醇筛查的普及，以及有效和耐受性良好的降胆固醇药物的存在。这些领域的进展引起了关于谁应该为冠状动脉事件的一级或二级预防进行筛查和治疗的争议。他汀类降脂剂的出现代表了一大进步，因为它们比以前的降脂剂更有效，耐受性更好。人们普遍认为，高胆固醇血症和已确诊的冠心病患者需要接受二级预防复发冠状动脉事件的治疗。一级预防在除糖尿病患者以外的所有患者群体中都存在争议，因为他们患冠心病的风险显著增加。绝经后的妇女和老年人得不到足够的治疗，而年轻人可能得不到充分的诊断和治疗。正在进行的几项试验解决了关于哪些患者群体将从不同的预防和治疗策略中受益的争议。
Coronary heart disease (CHID) remains a leading cause of morbidity and mortality in the United States, despite our better understanding of the pathobiology of atherosclerosis, our knowledge of risk factors, the widespread availability of inexpensive cholesterol screening, and the availability of effective and well-tolerated cholesterol-lowering agents. Advances in these areas have created controversies regarding who should be screened and treated for primary or secondary prevention of coronary events. The advent of the statin class of lipid-lowering agents represented a major advance, because they are much more effective and better tolerated than previous agents. There is general agreement that patients with hypercholesterolemia and established CHD require treatment for secondary prevention of recurrent coronary events. Primary prevention is controversial in all patient groups except those with diabetes, because their risk of developing CHD is dramatically increased. Postmenopausal women and the elderly are undertreated, whereas young adults may be underdiagnosed and undertreated. Several ongoing trials tray resolve the controversies about which patient groups will benefit from different prevention and treatment strategies.