Læknaneminn - 01.04.1998, Qupperneq 21

Faraldsfræði kransæðasjúkdóms
HVAÐ SVO?
Það er von höfundar að þessi skrif hafi komið til skila
þeirri sannfæringu að enn sé mörg verk að vinna í far-
aldsfræði kransæðasjúkdóms en þó öllu fremur í hag-
nýtingu þekkingarinnar. Við þurfum að berjast í fyrstu
víglínu (primary prevention) en einnig í öllum þeim
víglínum sem fela í sér “secondary prevention”. I fyrstu
víglínu þarf bæði að leita uppi þá sem búa við mikla
áhættu (“high risk strategy”) og leitast við að hafa áhrif
á lifnaðarhætti þjóðarinnar (“population strategy”). A
þeim vettvangi eru margir kallaðir til ábyrgðar, foreldr-
ar, kennarar, stjórnmálamenn, rithöfundar, leikhúsfólk,
kvikmyndagerðarmenn, keppnisíþróttamenn og ýmsar
heilbrigðisstéttir. Að oldcur snýr sú staðreynd að fjöl-
margar rannsóknir hafa sýnt að möguleikar lækna til að
hafa áhrif á þessum vettvangi eru meiri en flestra ef ekki
allra annarra stétta. Ásamt foreldrum verða Iæknar því
að axla hina þyngstu ábyrgð.
HEIMILDIR
1. H. Blackburn: Contribution of epidemiology to cardiovascular
health. Am J Cardiol 1996; 78: 1267-1272.
2. H. Blackburn: The concept of risk. í Primer in Preventive Cardi-
ology, T. Pearson o.fl. ritstjórar. 1994. American Heart Association,
Dallas.
3. Task Force of the European Society of Cardiovascular Mortality and
Morbidity Statistics in Europe. S. Sans, H. Kesteloot, D. Kromhout
on behalf of the Task Force: The burden of cardiovascular disease
mortality in Europe. Eur Heart J 1997; 18: 1231-1248.
4. G.L.Burke, J.M. Sprafka, A.R. Folsun, R.V. Luepker, S.W. Norsted,
H. Blackburn: Trends in CHD mortality, morbidity and risk factor
levels from 1960 to 1986. The Minnesota heart Survey. Int J Ep-
idemiol 1989; 18 (suppl 1) S75-S81.
5. M. Yamada, F.L Wong, K. Kodama, H. Sasaki, K. Shiaoka, M.
Yamakido: Longitudinal trends in total serum cholesterol levels in a
Japanese cohort, 1958-1986. J Clin Epidemiol 1197; 50: 425-434.
6. J.V. Neal: Diabetes mellitus: a “thrifty genotype” rendered detri-
mental by “progress”? Am J Hum Genet 1962; 14: 352-362.
7. W.F. Enos, Jr., J.C. Beyer, R.H. Holmes: Pathogenesis of coronary
heart disease in American soldiers killed in Korea. JAMA 1955; 158:
912-914.
8. M. Bobak, M. Marmot: East-West mortality divide and its potenti-
al explanations: proposed research agenda. Br Med J 1996; 312:
421-425.
9. N. Sigfússon, H. Sigvaldason, L. Steingrímsdóttir, G. Sigurðsson:
Decline in ischemic heart disease in Iceland and change in risk fact-
orlevels. BrMedJ 1991; 302: 1371-1375.
10. Guðmundur Þorgeirsson, Davíð Davíðsson, Helgi Sigvaldason,
Nikulás Sigfússon: Áhættuþættir kransæðasjúkdóms meðal karla og
kvenna á Islandi. Niðurstöður úr hóprannsókn Hjartaverndar 1967-
1985. Læknablaðið 1992; 78:267-276.
11. E. Sigurðsson, N. Sigfusson, H: Sigvaldason, G. Thorgeirsson:
Silent ST-T changes in an epidemiologic cohort study-A marker of
hypertension or coronary heart disease or both: The Reykjavik Study.
J Am Coll Cardiol 1996; 27:1140-1147.
12. J. Stamler, D. Wentworth, J.D. Neaton: Is the relationship between
serum cholesterol and risk of premature death from coronary heart
disease continuous and graded? Finding in356.222 primary screenes
of the Multiple Risk Factor Intervention trial (MRFIT). JAMA
1986; 256: 2823-2828.
13. M.H. Alderman: Blood pressure management: Individualized treat-
ment based on absolute risk and the potential for benefit.Ann Intern
Med 1993; 119: 329-335.
14. H. Kesteloot: Review. Nutrition and health. Eur Heart J 1992;
13:120-128.
15. Guðmundur Þorgeirsson, Gunnar Sigurðsson, Jón Högnason, Sig-
urður Helgason: Blóðfitulækkandi lyfjameðferð. Læknablaðið 1996;
82. 734-735.
16. K. Pyörala, G. De Backer, I. Graham, P. Poole-wilson, D. Wood, on
behalf of the Task Force: Prevention of coronary heart disease in cl-
inical practice: recommendations of the Task Force of the European
society Cardiology, European Society of Cardiology, European
Athersclerosis Society and European Society of Hypertension. Eur
heart J 1994; 15: 1300-1341.
17. K. Kristjánsson, N. Sigfússon, H. Sigvaldason, G. Thorgeirsson:
Glucose tolerance and blood pressure in a population-based cohort
study of males and females: the Reykjavik Study. J Hypertens 1995;
13: 581-586.
18. E. Sigurðsson, G. Thorgeirsson, H. Sigvaldason, N. Sigfússon:
Prevalence of coronary heart disease in Icelandic men 1968-1986.
The Reykjavik Study. Eur Heart J 1993; 14: 584-591.
19. Scandinavian Simvastatin Survival Study Group: randomised trial of
cholesterol lowering in 4444 patients with coronary artery disease:
the Scandinavian Simvastatin Survival Study (4S). Lancet 1994;
344; 1383-1389.
20. E.Sigurdsson, G. Thorgeirsson, H. Sigvaldason, N. Sigfússon: Un-
recognized myocardial infarction: Epidemiology, clinical character-
istics, and the prognostic role of angina pectoris. The Reykjavik Stu-
dy. Ann Int Med 1995; 122: 96-102.
21. R. Peto, A.D. Lopez, J. Boreham, M. Thun, C. Heath Jr.: Mortality
from tobacco in developed countries: indirect estimation from
national vital statistics. Lancet 1992; 339: 1268-1278.
22. D.S. Celermajer, M.R. Adams, P. Clarkson, J. Robinson, R.
McCredie, A. Donald, J.E. Deanfield. Passive smoking and
impaired endothelium-dependent arterial dilatation in healthy
young adults. N Engl J Med 1996; 334: 150-154.
23. E.J. Neufeld, M. Mietus-Snyder, A.S. Beiser, A.L.Baker,
J.W.Newburger: Passive cigarette smoking and reduced HDL cho-
lesterol levels in children with high-risk lipid profiles. Circulation
1997; 96: 1403-1407.
24. J.H. Dwyer: Exposure to environmental tobacco smoke and coron-
ary risk. Circulation 1997; 96: 1367-1369.
LÆKNANEMINN • 1. tbl. 1998, 51. árg.
19