CHANGING PERSPECTIVES IN THE PREVENTION OF CORONARY-ARTERY DISEASE
CHANGING PERSPECTIVES IN THE PREVENTION OF CORONARY-ARTERY DISEASE
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DOI：
10.1016/0002-9149(86)90661-2
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发表时间：
1986-05-30
影响因子：
2.8
通讯作者：
LEVY, RI
中科院分区：
文献类型：
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作者：
LEVY, RI
今天的问题不再是降低胆固醇是否有益于那些有冠心病风险的人;现在的问题是什么时候，谁和如何治疗，非常感兴趣的领域包括目前的试验结果外推到低密度脂蛋白的饮食和药物，并评估通过药理学手段增加高密度脂蛋白水平的价值。我们需要决定哪些测量（总胆固醇、脂蛋白胆固醇或脂蛋白载脂蛋白水平）对高危患者的诊断、治疗和随访最有价值。包括最近出版的美国国立卫生研究院降胆固醇共识小组的建议在内的建议表明，我们的诊断和治疗指数应该比现在低得多。为了成功地采用更积极的方法降低胆固醇，我们需要更好地支持，教育和激励高危患者。医生需要更多地了解什么是血浆胆固醇以及如何改变它。必须开发提高患者对饮食和药物治疗依从性的方法。我们需要改变一生的习惯，如果我们要取得成功，我们需要食品行业和更知情的消费者的帮助，他们知道如何阅读食品标签。最终，我们将需要一个双管齐下的方法，集中在医生和广大公众。
Today the question is no longer whether cholesterol reduction is beneficial for those at risk for coronary artery disease; the questions now are when, whom and how to treat. Areas of great interest include extrapolation of current trial results to low density lipoprotein reduction by diet and drugs, and assessment of the value of increasing high density lipoprotein levels by pharmacologic means. We will need to decide what measurements (total cholesterol, lipoprotein cholesterol or lipoprotein apoprotein levels) are of most value to the diagnosis, treatment and follow-up of the at-risk patient. Recommendations, including those of the recently published National Institutes of Health Consensus Panel on Cholesterol Lowering, suggest that our index for diagnosis and treatment should be set considerably lower than it is today. To be successful with a more aggressive approach to cholesterol lowering, we will need to better support, educate and motivate the at-risk patient. Physicians need to become more knowledgeable about what plasma cholesterol is and how to change it. Methods that enhance patient adherence to diet and drug therapy must be developed. We will need to alter lifetime habits and will need the help of both the food industry and better informed consumers, knowledgeable on how to read food labels, if we are to succeed. Ultimately, we will need a 2-pronged approach, focusing on both the physician and the public at large.