Advertisement

Cholesterinscreening: Die Irrationalität von Grenzwerten und die Berücksichtigung des Gesamtrisikos für eine rationale Therapie

  • Johannes G. Schmidt

Zusammenfassung

In Forschung und Praxis wird das Problem prophylaktischer Maßnahmen und Behandlungen meist ausschließlich auf die Frage reduziert: kann eine Früherkennung bzw. eine frühzeitige Risikofaktorbehandlung die Folgekrankheit kausal beeinflussen? Von einer praktischen Sichtweise wäre allerdings die Frage wichtig: Überwiegen die erwünschten Auswirkungen solcher prophylaktischen Maßnahmen die unerwünschten Auswirkungen, und durch welche Parameter sollen solche Wirkungen gemessen werden?

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. 1.
    American Heart Association (1973) Coronary risk. HandbookGoogle Scholar
  2. 2.
    Bloom JR, Monterossa S (1981) Hypertensive labelling and sense of well-being. Am J Public Helth 71:1228–1232CrossRefGoogle Scholar
  3. 3.
    Broughton PM, Bullock DG, Cramb R (1990) Improving the quality of plasma cholesterol measurements in primary case. Scand J Clin Lab Invest [Suppl] 198:43–48CrossRefGoogle Scholar
  4. 4.
    Committee of Principal Investigators (1984) WHO trial on primary prevention of IHD with Clofibrat to lower serum cholesterol: Final mortality follow-up. Lancet II: 600–604Google Scholar
  5. 5.
    Coronary Drug Project Research Group (1975) Clofibrate and niacin in CHD. JAMA 231:360–381CrossRefGoogle Scholar
  6. 6.
    Dorr AE, Gundersen K, Schneider Jr JC, Spencer TW, Martin WB (1978) Colestipol hydrochloride in hypercholesterolemic patients — effect on serum cholesterol and mortality. J Chronic Dis 31:5–14PubMedCrossRefGoogle Scholar
  7. 7.
    Fletcher RH, Fletcher SW, Wagner EH (1982) Clinical epidemiology: the essentials. Williams & Wilkins, Baltimore LondonGoogle Scholar
  8. 8.
    Frantz ID, Daxson EA, Ashman PL et al. (1989) Test of effect or lipid-lowering by diet of cardiovascular risk. The Minnesota Coronary Survey. Arteriosclerosis 9:129–135Google Scholar
  9. 9.
    Frick MH, Elo O, Haapa K et al. (1987) Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease. N Engl J Med 317:1237–1245Google Scholar
  10. 10.
    Gordon T, Kagan A, Garcia Palmiori M et al. (1981) Diet and its relation to CHD and deaths in three populations. Circulation 63:500–515PubMedCrossRefGoogle Scholar
  11. 11.
    Havas S, Reisman J, Hsu L, Koumjian L (1991) Does cholesterol screening result in negative labelling effects? Arch Intern Med 151:113–119PubMedCrossRefGoogle Scholar
  12. 12.
    Haynes RB, Sackett DL, Tylor DW, Gibson ES, Johnson AL (1978) Increased absenteeism from work after detection and labelling of hypertensive patients. N Engl J Med 1978; 299:741–744CrossRefGoogle Scholar
  13. 13.
    Hegsted DM, Nicolosi RJ (1987) Individual variation in serum cholesterol levels. Proc Natl Acad Sci 84:6259–6261PubMedCrossRefGoogle Scholar
  14. 14.
    Isles CG, Hole DJ, Gillis CR et al. (1989) Plasma cholesterol, coronary heart disease, and cancer in the Renfrew and Paisley survey. Br Med J 298:920–924CrossRefGoogle Scholar
  15. 15.
    Kannel WB, Castelli WP, Gordon T (1979) Cholesterol in the prediction of arteriosclerotic heart disease. New perspectives based on the Framingham Study. Ann Intern Med 90:1985–1991Google Scholar
  16. 16.
    Keys A, Aravanis C, Blackburn H et al. (1972) Probability of middle-aged men developing coronary heart disease in five years. Circulation 45:815–828PubMedGoogle Scholar
  17. 17.
    Kromhout D, Bosschieter EB, de Lezenne CC (1982) Dietary fibre and 10-year mortality from CHD, cancer, and all causes. Lancet II: 518–522CrossRefGoogle Scholar
  18. 18.
    Kromhout D, Bosschieter EB, de Lezenne CC (1985) The inverse relation between fish consumption and 20-year mortality from CHD. N Eng J Med 312:1205–1209CrossRefGoogle Scholar
  19. 19.
    The Lipid Research Clinics Coronary Primary Prevention (1984) Trial results: I. Reduction in incidence of coronary heart disease. JAMA 251:351–364Google Scholar
  20. 20.
    Macdonald LA, Sackett DL, Haynes RB et al. (1984) Labelling in hypertension: a review of the behavioural and psychological consequences. J Dis 37:933–942CrossRefGoogle Scholar
  21. 21.
    Mensink RP, Katan MB (1990) Effect of dietary trans fatty acids on high-density and low-density lipoprotein cholesterol levels in healthy subjects. N Engl J Med 323:439–445PubMedCrossRefGoogle Scholar
  22. 22.
    Miettinen TA, Huttunen JK, Nankkarinen V et al. (1985) Multifactorial primary prevention of cardiovascular disease in middle-aged men: Risk factor changes, incidence, and mortality. JAMA 254:2097–2102PubMedCrossRefGoogle Scholar
  23. 23.
    Mogadam M, Ahmed SW, Mensch AH, Godwin ID (1990) Within-person fluctuations of serum cholesterol and lipoproteins. Arch Intern Med 150:1645–1648PubMedCrossRefGoogle Scholar
  24. 24.
    Morris JN (1977) Diet and heart: A postscript. Br Med J II: 1307–1314CrossRefGoogle Scholar
  25. 25.
    Muldoon MF, Manuck JB, Matthews KA (1990) Lowering cholesterol concentrations and mortality: a quantitative review of primary prevention trials. Br Med J 301:309–314CrossRefGoogle Scholar
  26. 26.
    Sackett DL, Haynes RB, Tugwell P (1985) Clinical epidemiology: a basic science for clinical medicine. Little, Brown & Company, Boston TorontoGoogle Scholar
  27. 27.
    Schmidt J (1987) Risiko und Nutzen einer Behandlung: das Beispiel Clofibrat. Schweiz Med Wochenschr 117:773–776PubMedGoogle Scholar
  28. 28.
    Schmidt JG (1990) Wie sinnvoll ist ein Cholesterin-Screening? Z Allg Med 66:789–794Google Scholar
  29. 29.
    Stamler J (1987) Lifestyle, major risk factors, proof and public policy. Circulation 58:3–19Google Scholar
  30. 30.
    Thompson SG, Pocock SI (1990) The variability of serum cholesterol measurements: implications for screening and monitoring. J Clin Epidemiol 43:783–789PubMedCrossRefGoogle Scholar
  31. 31.
    The Toronto Working Group on Cholesterol Policy (1990) Asymptomatic hypercholesterolemia: a clinical policy review. J Clin Epidemiol 43:1028–1121Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1991

Authors and Affiliations

  • Johannes G. Schmidt

There are no affiliations available

Personalised recommendations