非侵入性膽固醇皮膚測試可以確認無症狀的粥狀動脈硬化


  March 7, 2005(奧蘭多)-一項小型試驗結果顯示,一種新的、市面上可進行之試驗,用來偵測皮膚膽固醇的濃度,可以確認早期、無症狀的粥狀動脈硬化風險因子,研究人員今天於美國心臟學會2005年會中發表這項結果。
  
  麥迪森威斯康辛大學預防心臟學計畫共同主任James H. Stein醫師表示,皮膚膽固醇測試與利用超音波測量頸動脈血管內膜厚度相符;他向Medscape表示,皮膚測試並非作為膽固醇血液測試的替代品,他表示,這個試驗的優點是快速,僅需要不到5分鐘的時間就可以得知結果,而且這個試驗不需要像測量血中膽固醇濃度一樣需要空腹,這個試驗衡量皮膚裡的固醇量。
  
  Stein醫師認為,理想中,這個試驗是將心臟血管風險評估帶回醫師的辦公室裡;他解釋,現在,如果我們懷疑某位病患可能有粥狀動脈硬化風險,我們將病患轉介接受更多的檢驗;此外,因為這個試驗可以找出沒有症狀的病患,我們開始積極的次發預防措施。
  
  在進行皮膚測試時,一片小小的膠膜放置在掌心,並且將一滴液體滴到一個孔洞中;孔洞中的顏色變化代表皮膚固醇的含量;Stein醫師表示,顏色變化是透過一種電子細管通過孔洞來辨識。
  
  這項單一中心試驗評估皮膚(PREVU,由McNeil消費者健康照護公司行銷)的試驗,針對81位沒有血管疾病的連續病患,這些都是被轉介透過頸動脈超音波評估頸動脈血管內皮厚度的病患。
  
  病患平均年齡為56歲,而平均膽固醇濃度為95.9 ± 18.3單位;Stein醫師表示,隨著膽固醇濃度增加,頸動脈壁厚度增厚的風險越高;血中膽固醇濃度較高的前4分之1病患,透過頸動脈超音波測量的頸動脈血管內皮厚度明顯地較厚(0.87 mm相較於0.76 mm,P=.011)。
  
  整體皮膚膽固醇濃度,與頸動脈增厚之間的關係與年齡、性別、收縮壓、血脂濃度及使用降血脂療法無關(P=.031);此外,皮膚整體膽固醇,在校正過Framingham風險因子後,與頸動脈血管內皮厚度增厚的風險提高有關(勝算比為1.341;95%信賴區間為1.302-1.380;P=.048)。
  
  佛羅里達梅約醫學中心心臟科醫師Gerald Fletcher醫師表示,這項新試驗可能是一種以辦公室為主的風險評估很好的選擇,而且這也可能鼓勵醫師與病患討論如何降低風險;Fletcher醫師表示,有7種可以修飾的風險因子,包括血壓、膽固醇、肥胖、長時間需要坐著的生活型態、吸菸與糖尿病,都可以在初級照護診間中向病患強調這些風險因子。

Noninvasive Cholesterol Skin T

By Peggy Peck
Medscape Medical News

March 7, 2005 (Orlando) — Results from a small study of a new, commercially available test for skin cholesterol levels indicate that the test is a useful tool for identifying patients at risk of early, asymptomatic atherosclerosis, researchers reported here today at the American College of Cardiology 2005 Annual Scientific Session.

The skin cholesterol measurement correlates to ultrasound measurement of carotid intima-media thickness, said James H. Stein, MD, codirector of the University of Wisconsin preventive cardiology program in Madison. He told Medscape that the skin test is not intended as a substitute or replacement for blood tests for cholesterol. Among the advantages of the test, he said, are speedy results — it takes fewer than five minutes — and it eliminates the need for fasting that is required with cholesterol blood tests. The test measures the amount of sterol in the skin.

"Ideally, I see this test as something that brings cardiovascular risk assessment back into the physician's office," Dr. Stein said. He explained that "right now when we suspect that a patient may be at risk for atherosclerosis, we refer out for additional tests. This test is fast and simple and gets the risk assessment discussion started in the office." Moreover, because the test can identify asymptomatic patients, "we can begin aggressive secondary prevention measures," he said.

During the skin test, a small foam pad is placed on the palm and liquid is dropped into small "wells" in the pad. "The color of the well changes to indicate the level of sterol in the skin," Dr. Stein said. That color change is read by an electronic wand that is passed over the foam pad.

The single-center study assessed the skin test (PREVU, marketed by McNeil Consumer Healthcare) in 81 consecutive patients without known vascular disease who were referred for evaluation of carotid intima-media thickness by carotid ultrasound.

The average age of patients was 56 years, and mean skin total cholesterol was 95.9 ± 18.3 units. "As sterol levels increased, so did the risk of carotid wall thickness," Dr. Stein said. Carotid intima-media thickness, measured by ultrasound, was significantly higher among those in the highest quartile of total cholesterol levels (0.87 mm vs 0.76 mm; P = .011).

The relationship between total skin cholesterol levels and carotid thickening was independent of age, sex; glucose, systolic blood pressure, and blood lipid levels; and use of lipid-lowering therapy (P = .031). In addition, skin total cholesterol was associated with an increased risk of carotid wall thickening after adjusting for Framingham risk score (odds ratio, 1.341; 95% confidence interval, 1.302 – 1.380; P = .048).

Mayo Clinic Florida cardiologist Gerald Fletcher, MD, said the new test may be a good option for office-based risk assessment, and it may encourage physicians to discuss risk modification with patients. "There are six modifiable risk factors: blood pressure, cholesterol, obesity, sedentary lifestyle, smoking, and diabetes. All of these can be addressed in the primary care office," Dr. Fletcher said.

ACC 2005 Annual Scientific Session: Abstract 820-4. Presented March 7, 2005.

Reviewed by Gary D. Vogin, MD

    
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