<International Circulation>: How important do you think early treatment of blood pressure and cholesterol and use of aspirin is? Looking at the ten year prognosis， if one has say a 4% risk over the next ten years， you don’t need to take these measures yet. Is that a valid statement?

  《国际循环》：您认为对血压和胆固醇的早期治疗以及阿司匹林的使用有多重要？如果一个人在未来十年内有4%的心血管发病风险，则尚不需要采取以上措施，是这样吗？

    Prof.Tomaselli: Early treatment may be different philosophically than later treatment. Early treatment means early interventions that are non-pharmacological for cholesterol， for example. Blood pressure on the other hand， if detected early should be treated early. If it cannot be corrected by changes in diet with respect to sodium and increased activity or weight loss， blood pressure needs to be treated pharmacologically early. For cholesterol， unless it is really high， I think we are a little bit more challenged. Where do we set that LDLc target， particularly in younger people? The new guidelines in the United States for children have recommended that between the ages of nine and eleven， children should have their cholesterol measured. The questions raised there are， how many children are going to have elevated cholesterol? If we use a cut-off of 130 as in previous guidelines， the estimate is up to around 10% of kids. If you use a familial hypercholesterolemia cut-off of an LDLc of 190， it is <1%. This might be an issue of whether or not we should be drawing that blood in the first place but at the lower levels of cholesterol， I don’t think we should be making recommendations for pharmacological treatment of those kids yet. We need to intervene in lifestyle. On the other hand， if you have familial hypercholesterolemic levels of cholesterol， then that may be a child or young adult that needs to be treated early.

    Tomaselli教授：从哲学上说，早期治疗和晚期治疗可能不同。例如，早期治疗意味着对胆固醇的早期非药物性干预。对于血压来说，如果早期发现高血压则应当早期治疗。如果不能通过低钠饮食，增加运动或者减肥来纠正，则需要早期药物治疗。对于胆固醇，除非胆固醇的确升高，我认为这方面的研究，挑战更多一些。对于人们尤其是较年轻的人，我们应当如何设置LDL-C目标呢？新的美国针对儿童的指南，我们推荐在9岁到11岁之间，儿童应当检查胆固醇水平。问题来了，有多少儿童胆固醇升高呢？如果我们使用过去指南中的130mg/dL的切点，大约有10%的儿童胆固醇升高。如果我们使用家族性高胆固醇血症的切点，即LDL-C>190mg/dL，则<1%。问题在于我们是将控制血压还是控制胆固醇放在第一位。我认为对于这些儿童，不应当推荐药物治疗，而应当干预其生活方式。另外一方面，如果有家族性高胆固醇血症，那么不管是儿童还是年轻人，都应当接受药物治疗。

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