代谢综合征危险因子的相关性分析

目的分析德州市代谢综合征(MS)危险因子的临床特点。方法对2009年德州市机关人员(20～60岁)医保查体资料进行分析,将被调查对象按年龄分为20～30岁、31～40岁、41～50岁和51～60岁四组,分析其MS危险因子—中心性肥胖(男腰围≥90 cm,女腰围≥80 cm)、高收缩压(≥130 mmHg)或高舒张压(≥85 mmHg)、高血糖(空腹血糖≥5.6 mmol/L)、高甘油三酯(≥1.7 mmol/L)以及高密度脂蛋白胆固醇水平降低(c男<1.03 mmol/L,c女<1.29 mmol/L)在不同年龄组的特点。结果 20～30岁组各个危险因子发生率从高到低排列分别为:中心性肥胖(50%)、高甘油三酯(39%)、高密度脂蛋白胆固醇水平降低(37%)、高舒张压(33%)、高收缩压(22%)、高血糖(6%);31～40岁组各个危险因子发生率从高到低排列分别为:中心性肥胖(57%)、高舒张压(47%)、高甘油三酯(41%)、高密度脂蛋白胆固醇水平降低(32%)、高收缩压(26%)、高血糖(14%);41～50岁组各个危险因子发生率从高到低排列分别为:中心性肥胖(71%)、高舒张压(67%)、高收缩压(66%)、高甘油三酯(54%)、高密度脂蛋白胆固醇水平降低(31%)、高血糖(26%);51～60岁组各个危险因子发生率从高到低排列分别为:高舒张压(68%)、高收缩压(63%)、中心性肥胖(58%)、高甘油三酯(50%)、高密度脂蛋白胆固醇水平降低(30%)、高血糖(27%)。结论中心性肥胖和高甘油三酯是德州市机关人员MS的首发和主要的危险因子,高血压和高血糖是MS的晚发临床表现。     

Plasma lipids and lipoproteins and the prevalence of risk for coronary heart disease in Canadian adults. Canadian Heart Health Surveys Research Group.

OBJECTIVE: To report population reference values for blood lipids, to determine the prevalence of lipid risk factors and to assess their association with other risk factors. DESIGN: Population-based cross-sectional surveys. Survey participants were interviewed at home and provided a blood sample at a clinic. All blood lipid analyses were done in the Lipid Research Laboratory, University of Toronto. The laboratory is standardized in the National Heart, Lung Blood Institute-Centres for Disease Control Standardization Program. SETTING: Nine Canadian provinces, from 1986 to 1990. PARTICIPANTS: A probability sample of 26,293 men and women aged 18 to 74 was selected from the health insurance registers for each province. Blood samples were obtained from 16,924 participants who had fasted 8 hours or more. OUTCOME MEASURES: Concentration of total plasma cholesterol, triglycerides and high density lipoprotein (HDL) and low density lipoprotein (LDL) cholesterol in blood samples from fasting participants. MAIN RESULTS: Of the study population, 46% had total plasma cholesterol levels above 5.2 mmol/L, 15% had LDL-cholesterol levels above 4.1 mmol/L, 15% had triglyceride levels above 2.3 mmol/L and 8% had HDL-cholesterol levels below 0.9 mmol/L. Total plasma cholesterol, LDL-cholesterol and triglyceride levels rose with age in men to a maximum in the 45-54 age group; in women there was little change with age up to ages 45 to 54, at which time the level of each of these lipids increased appreciably. The age-standardized prevalence of obesity was positively associated with elevation of total plasma cholesterol. CONCLUSION: The results suggest the need for a multifactorial approach in health promotion efforts to lower blood cholesterol levels and reduce other risk factors in the population. A considerable number of adults were found to be at risk at all ages in both sexes. In the short term, men aged 34 and older and women aged 45 and older might benefit most from prevention programs.     

Guidelines for the detection of high-risk lipoprotein profiles and the treatment of dyslipoproteinemias. Canadian Lipoprotein Conference Ad Hoc Committee on Guidelines for Dyslipoproteinemias.

Elevated plasma levels of cholesterol and triglycerides, low levels of high-density lipoproteins, hypertension, diabetes mellitus, smoking and abdominal obesity are risk factors for coronary heart disease (CHD) and stroke. Because of the preventable threat to life, well-being and productivity from perturbations of plasma lipoproteins (which affect about 60% of adults), we recommend a population-based strategy with public education on diet, exercise and the hazards of smoking and legislation for better food labelling. This should be combined with the medical guidelines we describe to detect and treat those at highest risk for CHD (including about 15% of adults), who merit priority for the medical, dietetic and laboratory services required. Among people aged 40 years or more this includes those with plasma total cholesterol levels greater than 7 mmol/L, fasting triglyceride levels greater than 3 mmol/L or cholesterol level greater than 6 mmol/L when associated with CHD or other risk factors for CHD. For younger people the criteria for highest risk include cholesterol levels greater than 6.5 mmol/L for those aged 30 to 39 years, greater than 6 mmol/L for those aged 20 to 29 and greater than 5 mmol/L for those under age 20.     

老年脑梗死患者血清胆固醇、高密度脂蛋白及其图谱的变化

OBJECTIVE: To investigate the changes in the levels of serum cholesterol and high-density lipoprotein and in serum lipoprotein electrophoretogram in elderly patients with cerebral infarction. METHODS: Serum lipoprotein electrophoretograms (SLPG) of 118 elderly patients with cerebral infarction and 60 healthy elderly subjects were measured by means of double gradient polyacrylamide gel electrophoresis, and the serum concentrations of total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) were determined by enzymatic method. RESULTS: Compared with the control group, the serum level of HDL-C was significantly increased in the patients (1.0+/-0.3 mmol/L), who also had decreased TC/HDL-C ratio (5.3+/-1.4), but no significant difference occurred in terms of TC concentration between these two groups. Among the patients with cerebral infarction, 86.4% had abnormalities of SLPG, especially in the alpha-lipoprotein electrophoretogram (P<0.001-0.05) regardless of HDL-C elevations. CONCLUSIONS: Decreased HDL-C, elevated TC/HDL-C ratio and abnormal SLPG may be the risk factors for the onset of cerebral infarction in senior patients, for which alpha-lipoprotein electrophoretogram can be more sensitive than serum HDL-C level. TC levels is of little value in predicting cerebral infarction.     

The effect of filtered-coffee consumption on plasma lipid levels. Results of a randomized clinical trial.

OBJECTIVE.--To determine the effect of filtered-coffee consumption on plasma lipoprotein cholesterol levels in healthy men. DESIGN.--Randomized controlled trial with an 8-week washout period followed by an 8-week intervention period during which men were randomly assigned to drink 720 mL/d of caffeinated coffee, 360 mL/d of caffeinated coffee, 720 mL/d of decaffeinated coffee, or no coffee. SETTING.--Outpatient clinical research center in a university medical center. PARTICIPANTS.--One hundred healthy male volunteers. OUTCOME MEASURE.--Changes in plasma lipoprotein cholesterol levels during the intervention period. RESULTS.--Men who consumed 720 mL of caffeinated coffee daily had mean increases in plasma levels of total cholesterol (0.24 mmol/L, P = .001), low-density lipoprotein cholesterol (0.17 mmol/L, P = .04), and high-density lipoprotein cholesterol (0.08 mmol/L, P = .03). No significant changes in these plasma lipoprotein levels occurred in the other groups. Compared with the group who drank no coffee the group who drank 720 mL/d of caffeinated coffee had increases in plasma levels of total cholesterol (0.25 mmol/L, P = .02), low-density lipoprotein cholesterol (0.15 mmol/L, P = .17), and high-density lipoprotein cholesterol (0.09 mmol/L, P = .12) after adjustment for changes in diet. CONCLUSION.--Consumption of 720 mL/d of filtered, caffeinated coffee leads to a statistically significant increase in the plasma level of total cholesterol, which appears to be due to increases of both low-density lipoprotein and high-density lipoprotein cholesterol levels.     

脑梗死与血尿酸水平的关系探讨

目的探讨血尿酸（UA）水平与脑梗死伴颈动脉粥样硬化之间的关系。方法采用彩色多普勒超声分别对85例脑梗死患者和32例健康对照者进行颈动脉检测,同时测定他们的血UA及空腹血糖、总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白水平进行相关性分析。结果脑梗死患者血UA平均水平（389.69±98.28）mmol/L,显著高于对照组（224.51±88.60）mmol/L,两组比较差异有统计学意义（P〈0.01）;脑梗死组伴有颈动脉硬化患者血UA水平（427.31±88.70）mmol/L,高于未伴有颈动脉硬化患者（342.24±78.22）mmol/L,P〈0.05;血尿酸与空腹血糖、总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白无显著相关性,P〉0.05。结论血UA水平与脑梗死、颈动脉粥样硬化有一定相关关系,血UA是独立的致脑梗死危险因素。     

Trends in risk factors for vascular disease in Australia

Data from the National Heart Foundation Risk Factor Prevalence Surveys of 1980 and 1983 were analysed to detect national trends in risk factors for vascular disease in Australia. After statistical adjustment for differences in the demographic characteristics of the two populations of survey participants, our results show trends in smoking and blood pressure that are likely to result in a continuing fall in the incidence of vascular disease. There was a fall in the prevalence of current smoking from 32% to 29% but little change in the average daily consumption of cigarettes by current smokers. The prevalence of previously-undetected hypertension fell significantly from 10% to 7%. A small increase occurred in the proportion of all hypertensive patients who were treated and whose blood pressure was controlled, and a decline of 2.0 mmHg (P less than 0.0001) in mean diastolic blood pressures, but no significant change in mean systolic pressures. Mean total plasma cholesterol levels did not change; average levels of plasma triglycerides fell by 0.11 mmol/L (P less than 0.0001); and mean high-density lipoprotein cholesterol levels increased by 0.03 mol/L (P less than 0.0001). All indices of relative body weight increased between 1980 and 1983; mean body mass index rose by 0.23 with associated rises in the prevalence of obesity and of overweight status. The changes in other factors such as use of added salt, the consumption of alcohol, the level of physical activity and adherence to a special diet, all were in the desirable direction, although minor changes in the survey questionnaire might have served to exaggerate the apparent trends.     

基于有效预防冠心病发病的HDL-C水平的男性酒精适宜摄入量的探讨

目的探讨能够有效预防冠心病发病的男性酒精日摄入量范围。方法采用问卷调查结合血脂检测的方法,对758例只有饮用白酒习惯的男性结果进行分析。按照血清高密度脂蛋白胆固醇(HDL-C)水平是否大于1.55mmol/L分为两组,分析两组酒精日均摄入量差异的显著性。然后采用逐渐递增的方法,分别按照不同水平的酒精摄入量分组,分析每种情况下酒精摄入量的差异性,以出现差异不再具有统计学意义的分组水平作为能够预防冠心病发病的男性日均酒精摄入量的上限。结果 HDL-C>1.55mmol/L和HDL-C≤1.55mmol/L两组的酒精日均摄入量分别为35.23g、21.35g,差异具有显著性(P<0.0005)。从35g的酒精日均摄入量逐渐递增到75g以上时,两组HDL-C水平的差异均具有显著性(P<0.001);当进一步递增至80g以上时,两组差异的显著性消失。结论男性酒精日均摄入量在35-80g之内时,可以起到有效预防冠心病发病的作用。     

极高水平高密度脂蛋白胆固醇患者的临床特征分析

目的 在高密度脂蛋白胆固醇(HDL-C)水平极度升高会增加心血管死亡的背景下,分析具有HDL-C极高水平的心血管患者的临床特征,为探索HDL-C与心血管疾病的关系及进一步知晓HDL的代谢机制提供依据.方法 回顾分析2019年全年在中国医科大学附属第一医院心血管内科就诊并行血脂检测的成年患者信息.将HDL-C ≥2.59...     

血脂控制水平与PCI术后再狭窄的相关性分析

目的分析血脂控制水平与经皮冠状动脉介入(PCI)术后再狭窄的相关性。方法选取2016年3月-2018年3月我院收治的行PCI术的冠心病患者60例为研究对象,术后3个月行冠状动脉造影复查,根据有无再狭窄分为再狭窄组(n=28)和无狭窄组(n=32),比较两组一般资料、PCI前和PCI术后复查时的血脂水平,并对各影响因素进行相关性分析。结果再狭窄组的吸烟比例、糖尿病比例比无狭窄组更高;观察组复查时总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白水平均与PCI术前无明显差异(P均>0.05),而无狭窄组总胆固醇、甘油三酯、低密度脂蛋白水平比PCI术前显著降低,且低于PCI术后复查时再狭窄组,高密度脂蛋白较前明显升高,且高于PCI术后复查时再狭窄组(P均<0.05)。多因素分析显示,吸烟、合并糖尿病、PCI术后复查时总胆固醇、甘油三酯、低密度脂蛋白水平未下降,高密度脂蛋白未升高是PCI术后再狭窄的独立危险因素。结论 PCI术后总胆固醇、甘油三酯、低密度脂蛋白水平未下降,高密度脂蛋白未升高是PCI术后再狭窄的独立危险因素。     

The association of borderline hypertension with target organ changes and higher coronary risk. Tecumseh Blood Pressure study

The Tecumseh project investigates the evolution of hypertension in a healthy population. Of 946 subjects aged 18 through 38 years, 124 had clinic blood pressure readings higher than 140/90 mm Hg (the mean for borderline hypertensive subjects was 130/94 mm Hg). Compared with normotensive subjects, borderline hypertensive subjects had higher home blood pressures (mean, 12/7 mm Hg higher). Their childhood and postpubertal blood pressures were elevated (6/4 mm Hg higher than normal at age 6 years and 12/7 mm Hg higher than normal at age 21 years), and hypertensive target organ changes were detected. Borderline hypertensive subjects also had elevated minimal forearm resistance (0.22 U higher than normal), decreased stroke index (1.8 mL/m2 lower than normal), and impaired ventricular diastolic relaxation (mitral Doppler peak early diastolic blood flow [E] to peak late diastolic blood flow [A] ratio 0.13 lower than normal). Borderline hypertensive subjects had significant abnormalities in other coronary risk factors (cholesterol levels were 0.39 mmol/L higher, triglyceride levels were 0.45 mmol/L higher, high-density lipoprotein levels were 0.08 mmol/L lower, insulin levels were 38 pmol/L higher, and 16.5% more of them were overweight). Borderline hypertension is neither transient nor innocuous. Its association with other predictors of atherosclerosis calls for clinical attention.     

Hypercholesterolaemic effect of fish oil in insulin-dependent diabetic patients

The effect of the daily administration of Max EPA fish oil (equivalent to 2.7 g per day of eicosapentaenoic acid) on serum lipid levels was examined in insulin-dependent male diabetic patients with cholesterol levels of less than 6.5 mmol/L. After three weeks of fish-oil supplementation there was a significant rise in total cholesterol levels, which was due largely to increases in low-density lipoprotein (LDL)- and high-density lipoprotein (HDL)- cholesterol levels. The increase in HDL-cholesterol levels was accounted for by its HDL2 subclass. There was a decrease in serum triglyceride levels, but this was also observed in a control group of diabetic patients who did not receive fish oil and is probably explained by weight loss in this group. Similar changes in lipid levels were found in a subgroup of diabetic patients with retinopathy. The possible detrimental effect of the increase in total cholesterol and LDL-cholesterol levels after Max EPA fish oil at this dose may be offset by the selective rise in the protective HDL2 subclass.     

高甘油三酯血症与2型糖尿病的相关性分析

目的探讨高甘油三酯血症与2型糖尿病的相关性。方法对252例合并高甘油三酯血症的2型糖尿病（T2DM）患者的糖化血红蛋白（HbA1C）、甘油三酯（TG）、胆固醇（TC）、高密度脂蛋白-胆固醇（HDL-C）、低密度脂蛋白-胆固醇（LDL-C）做回顾性分析。根据NCEP-ATPⅢ将TG分为：正常水平〈1.7mmol/L,边缘性升高1.7～2.2mmol/L,高2.2～5.6mmol/L,很高≥5.6mmol/L。结果所有血脂中甘油三酯升高与2型糖尿病的相关性最强。结论甘油三酯水平增高是2型糖尿病相关的独立危险因素。血糖控制越差,甘油三酯水平越高。     

Clinical applications of fish oils

Fish oil supplements are currently being nationally advertised, and many physicians are being queried about their clinical utility. Epidemiologic studies reveal a low incidence of cardiovascular disease in people, such as the Eskimos, who eat large amounts of seafood. Cardiovascular health may be improved because fish and fish oil supplements lower plasma lipid levels (especially triglycerides), inhibit platelet aggregation, and may decrease blood pressure and viscosity and increase high-density lipoprotein (HDL) levels. Preliminary observations also suggest a potential future role for fish oils in the treatment of some autoimmune diseases, such as atopic dermatitis, psoriasis, and rheumatoid arthritis. Patients with serum triglyceride levels greater than 5.64 mmol/L and/or cholesterol levels greater than 7.75 mmol/L refractory to dietary management may benefit from a medically supervised trial of fish oil supplements. Data currently available are insufficient to recommend fish oil supplements for the general public, or for patients with other diseases, and side effects must also be considered. These include occasional adverse lipid changes, potential for bleeding and vitamin E deficiency, and, with some preparations, vitamin A and D toxicity.     

普伐他汀治疗肾移植术后血脂异常的临床研究

目的 探讨他汀类药物对肾移植术后血脂异常患者疗效及安全性。方法 21例肾移植术后高胆固醇血症患者（血浆总胆固醇TC水平〉6．2mmol／L），患者每日口服普伐他汀10mg，每晓1次，疗程8周。治疗前后测定本组及30例健康人（对照组）血清总胆固醇（TC）、低密度脂蛋白胆圊醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、甘油三酯（TG）、血浆内皮素（ET）、一氧化氮（NO）的变化。并采用高分辨血管外超声技术测定所有个体肱动脉血流介导的舒张功能及硝酸甘油介导的舒张功能。结果 血浆ET在肾移植组显著高于对照组，而NO显著低于对照组；降脂治疗8周后，ET明显下降（P〈0．01），NO明显升高（P〈0．01），血TC、LDL-C明显降低（P〈0．01），HDL-C亦升高，但无统计学意义。治疗组肱动脉血流介导的舒张低于对照组，治疗后较治疗前明显好转。没有病例发生横纹肌溶解。结论 肾移植患者普伐他汀调脂治疗的同时，可显著改善血管内皮细胞功能。普伐他汀治疗肾移植后高脂血症安全有效。     

The awareness of the risk of elevated cholesterol levels and knowledge about cholesterol-lowering action in Australia

We report on a survey of the frequency of the assessment of cholesterol levels and blood pressure in the Australian population. Attitudes to risk-factor modification for cardiovascular disease also were evaluated and emphasis was placed on the assessment of knowledge about dietary modification in relation to cardiovascular disease. Respondents in this survey more frequently reported that they had undergone a blood pressure assessment than that they had had their blood cholesterol levels measured (96% and 46% of respondents, respectively). The proportion (5%) of respondents who recalled a cholesterol assessment with elevated cholesterol levels was found to be substantially lower than was that for participants in the 1983 National Heart Foundation Risk Factor Prevalence Study (19% of men and 21% of women had cholesterol levels of more than 6.5 mmol/L). Very few (9%) respondents in this survey nominated that they would reduce their dietary fat intake in order to modify their risk of developing cardiovascular disease. However, a greater number of respondents answered appropriately when asked about their potential modification of specific food items. More than 80% of respondents reported that they would reduce their intake of fried foods, although fewer would minimize their intakes of dairy products and meat. Women and respondents with a higher level of education were found to be more likely to respond appropriately. In addition, of those respondents who recalled ever having had their blood cholesterol level measured, those who reported that they had an elevated cholesterol level were more likely to indicate appropriate dietary modifications compared with those who reported normal cholesterol levels. Cholesterol reduction continues to be an important public-health issue in Australia. The results of this survey indicate that there is a need for both increased identification of individuals with elevated cholesterol levels in the population and further educational programmes about the relationship among cholesterol, diet and cardiovascular disease.     

深圳学龄前儿童血脂水平研究

目的 了解深圳学龄前儿童血脂的正常值、临界值、危险值及深圳学龄前儿童的血脂异常率.方法 对深圳特区284名2～6岁学龄前儿童空腹12 h以上抽静脉血检测三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白AI（ApoAI）、载脂蛋白B（ApoB）.结果 2～6岁儿童TC、TG、HDL-C、LDL-C、ApoAI、ApoB的危险值分别为＞5.83 mmol/L,＞1.29 mmol/L,＜1.44 mmol/L,＞3.28 mmol/L,＜1.38 g/L,＞1.14 g/L.儿童血脂异常的总检出率为14.08%,以TC异常为主,不同年龄组儿童血脂异常率间差别无显著性意义（P＞0.05）;男童和女童的血脂异常率间差别无显著性意义（P＞0.05）.结论 血脂异常在2～6岁儿童中已存在一定比例,从儿童期开始高脂血症的预防对预防心血管病具有潜在效益.     

肝硬化合并上消化道出血与病人血脂水平的相关性研究

目的研究肝硬化合并上消化道出血与病人血脂水平的相关性。方法回顾性分析205例肝硬化病人一般资料,根据病人有无合并上消化道出血分为观察组（肝硬化合并上消化道出血,82例）和对照组（肝硬化,123例）。比较2组病人一般资料和血脂水平[三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）],并进行ROC曲线分析。根据观察组病人上消化道出血量分为轻症组和重症组,分析血脂水平与疾病严重程度的相关性。结果2组病人TG水平比较,差异无统计学意义（P>0.05）,但观察组病人TC、LDL-C和HDL-C水平均低于对照组（P < 0.01）;联合诊断的曲线下面积、敏感度和特异度均大于单一指标诊断,其中当TC≤2.69 mmol/L,HDL-C≤0.98 mmol/L,LDL-C≤1.61 mmol/L,肝硬化病人发生上消化道出血的概率均会增加（P < 0.01）;2组病人TG水平比较,差异无统计学意义（P>0.05）,但轻症组病人TC、LDL-C和HDL-C水平均高于重症组（P < 0.05~P < 0.01）;Spearman相关性分析显示TG与疾病严重程度无相关性（P>0.05）,TC、LDL-C和HDL-C均与疾病严重程度呈负相关关系（P < 0.05）。结论肝硬化合并上消化道出血病人血脂水平显著降低,且均与出血严重程度呈负相关,可作为肝硬化病人上消化道出血发生的预测因子。     

辛伐他汀治疗肾移植术后高脂血症的临床应用研究

目的 探讨他汀类药物对肾移植术后血脂异常的疗效。方法 将36例术后1年以上的高脂血症患者（血浆胆固醇总量水平＞6.35 mmol/L,低密度脂蛋白＞3.1 mmol/L）作为研究对象。所有患者均采取低脂饮食，测定患者血总胆固醇（TC）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、甘油三酯（TG）、载脂蛋白A（apoA）、载脂蛋白B（apoB）、肌酐（Cr），谷草转氨酶（GOT）及谷丙转氨酶（GPT）等各参数数值；然后给予辛伐他汀10 mg，每晚一次口服，测定用药后1，3，6，12个月后以上各参数值的变化。结果 肾移植术后高脂血症患者LDL较TC增高更为明显；用药后患者TC,LDL,TG,apoB分别于用药后第1,3,6,12个月时均出现显著性下降（P<0. 01），LDL的下降尤为明显；HDL于用药后第12个月时出现显著增高（P<0.05）；其余各项指标无显著变化；结论 辛伐他汀可有效、安全地用于治疗肾移植术后血脂异常。 【关键词】 肾移植 辛伐他汀 高脂血症     

The benefits of reducing cholesterol levels: the need to distinguish primary from secondary prevention. 2. Implications for heart disease prevention in Australia

OBJECTIVE: To estimate the number of coronary heart disease (CHD) events arising from the primary and secondary prevention populations of middle-aged Australian men, and the potential impact in each setting of lipid-lowering therapy on death from CHD. DESIGN: Analysis based on results of a meta-analysis of drug trials to lower cholesterol levels and data from the Hunter Region Heart Disease Prevention Programme. MAIN OUTCOME MEASURE: Death from CHD. RESULTS: Over a five-year period, 1520 fatal CHD events would be expected in a population of 100,000 men aged 35 to 69 years. Approximately 52% would arise from subjects already known to suffer from CHD. We predict that treating everyone in the secondary prevention group who has a blood cholesterol level of greater than 5.2 mmol/L (approximately 5000 subjects) would prevent 118 deaths, compared with 51 deaths prevented by treating those in the primary prevention group who have cholesterol levels of greater than 6.2 mmol/L (approximately 30,000 subjects). The outcome is maintained in several sensitivity analyses. CONCLUSIONS: The majority of persons in whom death from CHD might be prevented by treatment to lower cholesterol levels can be identified by targeting subjects for secondary prevention. Therapy in the secondary prevention setting is much more efficient than in primary prevention.