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為何重視高膽固醇血症

發佈日期:2013-12-31
發佈單位:華揚醫院-行政部
雖自1982年後,退居第二位;截至1998年,腦中風每年仍可奪走近一萬三~四千人生命。
心臟疾病,自1952年至1994年間,雖一直名列十大死因第四名,然而冠狀動脈心臟病則呈節節上昇之勢。台灣近五十年來的經濟發展與社會變遷,隨著工業化都市化的遞嬗,醫藥技術的發達,台灣地區居民的平均壽命足以媲美歐美先進國家。自民國八十二年九月,台灣已邁入聯合國所定義的老人國之列。腦血管及心臟血管疾病,皆為動脈血管粥狀硬化所引起之病變。

  在台灣,雖然動脈硬化性疾病的罹患率及死亡率皆較西方國家為低,然而隨著西化的飲食生活習慣及營養過剩,導致動脈硬化性疾病之增加,乃必然之趨勢。近年來,冠心病之顯著增加,且案例亦有年輕化之趨勢。因而動脈硬化性疾,將是現在和未來台灣最重要的公共衛生問題。

  高脂血症與心臟血管疾病的關係,基本上來自近四十年來的流行病學研究,遺傳疾病研究,動物實驗之結果,以及無數臨床試驗的證據。在早發性冠狀動脈心臟病研究上,發現早發性心肌梗塞病患其血中膽固醇特別高,尤其是具遺傳性家族高膽固醇血症的小孩; 而布朗和哥斯丁由這些研究更進一步發現低密度脂蛋白(LDL)之接受體,為膽固醇與動脈硬化的相關性找到理論的解釋,當然此一劃時代的發現為其獲得1985年諾貝爾獎。

高血膽固醇值與冠心病的罹患率與死亡率呈正相關,當中又以低密度膽固醇(LDL-C)呈最密切的相關。當血液在膽固醇高時,主要是低密度膽固醇增加的情況下,會使血管內皮細胞功能失常,若合併有其他危險因子(如高血壓、糖尿病、抽煙等)時,則內皮細胞功能失常更嚴重。致使浸入內皮層內的低密度膽固醇增加,進而引發一連串動脈硬化發生的反應,即巨噬細胞持續吞噬低密度膽固醇而導致細胞死亡,而形成泡沫細胞,終至發生了動脈硬化塊的形成。

  血膽固醇高的原因,基本上大部分是膽固醇代謝的問題,除了少數是續發性高脂血症(其他原因,例如甲狀腺功能低下、腎病症候群、阻塞性肝病、糖尿病控制不好等等外),大部分屬於原發性高脂血症。即是個人體質(遺傳是其中一部分)再加上環境因子作用下,表現出來的。

→治療上,除了必須找出續發性高脂血症之病因,加以治療。飲食治療是基本步驟,如果無法降至理想值時,則必須加上藥物治療。
→基本上,如果有動脈硬化疾病或証據時,應更積極以減少動脈硬化之進展及惡化。

截至目前之科學研究發現,結論是 --『膽固醇值高者會增加冠心病的罹病率和死亡率,然而經過非藥物或藥物的治療降低膽固醇值,確實可以明顯的減少冠心病的發生與死亡率,甚至可以延長壽命』。而最近的研究則指出,降膽固醇治療甚至可以預防老年癡呆,減少糖尿病的發生。所以請諸位關心自己健康的成年人,皆要定期身體檢查知道您固醇值,並且保持理想,這是預防動脈硬化疾病的第一步。
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