SHEFFIELD RISK AND TREATMENT TABLE FOR CHOLESTEROL-LOWERING FOR PRIMARY PREVENTION OF CORONARY HEART-DISEASE
SHEFFIELD RISK AND TREATMENT TABLE FOR CHOLESTEROL-LOWERING FOR PRIMARY PREVENTION OF CORONARY HEART-DISEASE
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DOI：
10.1016/s0140-6736(95)92477-9
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发表时间：
1995-12-02
期刊：
影响因子：
168.9
通讯作者：
RAMSAY, LE
中科院分区：
文献类型：
--
作者：
HAQ, IU;JACKSON, PR;RAMSAY, LE
当用于冠心病的二级预防时，使用羟甲基戊二酰辅酶A还原酶抑制剂的治疗导致值得的益处，其明显超过每年冠心病死亡风险为1.5%或更高的患者的任何风险。这一证据可以逻辑地外推到冠状动脉疾病的一级预防，只要治疗的目标是那些具有相似或更高的风险。我们提出了一个表格，细化以前提出的风险预测方法。该表识别了具有指定程度的冠状动脉风险的受试者;显示了赋予个体该风险程度的血清胆固醇浓度;并识别了不会具有该风险程度的受试者，无论其胆固醇浓度如何。它在日常实践中使用起来很简单。该表突出了年龄对冠状动脉风险的主要影响;没有血管疾病且年龄小于52岁的人不太可能具有特定程度的风险。即使在老年人（60-70岁）中，要达到这种程度的风险，通常也需要几个风险因素。有些人的血清胆固醇低至5.5 mmol/L时就可以接受降脂药物治疗，而有些人的血清胆固醇高至9.0 mmol/L时就不能接受降脂药物治疗。虽然降低胆固醇是预防高危人群发生冠心病事件的有效方法，但单靠测定胆固醇本身并不能很好地识别冠心病高危人群。随着关于治疗获益和风险的新证据的出现，该方法可以很容易地适应不同水平的冠状动脉风险。
When used for the secondary prevention of coronary heart disease, treatment with an inhibitor of hydroxymethylglutaryl-coenzyme-A reductase results in worthwhile benefit that clearly exceeds any risk in patients whose risk of coronary death is 1.5% or more per year. This evidence can be extrapolated logically to primary prevention of coronary disease provided that treatment is targeted at those with similar or higher risk.We present a table that refines previously proposed methods of risk prediction. The table identifies subjects who have the specified degree of coronary risk; shows the serum cholesterol concentration that confers that degree of risk in the individual; and identifies subjects who will not have this degree of risk, irrespective of their cholesterol concentration. It is simple enough for use in ordinary practice. The table highlights the predominant effect of age on coronary risk; a person who is free of vascular disease and younger than 52 years is unlikely to have the specified degree of risk. Even in older people (60-70 years) several risk factors are generally required to attain this degree of risk. Some people are candidates for lipid-lowering drug treatment with serum cholesterol as low as 5.5 mmol/L, whereas others with cholesterol as high as 9.0 mmol/L are not.Although cholesterol lowering is a powerful method for preventing coronary events in people at high risk, cholesterol measurement by itself is not a good way to identify those with high coronary risk. The method can be adapted readily to target a different level of coronary-risk as new evidence on the benefit and risk of treatment becomes available.