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Description de l’éditeur
Current Canadian guidelines to estimate the risk of vascular disease attributable to serum lipid concentrations require measurement of total cholesterol, triglycerides, and HDL cholesterol, as well as calculation of LDL cholesterol and the total cholesterol/HDL cholesterol ratio (1). The actual decision of whether therapy is necessary is determined on the basis of these values, as well as the presence of other risk factors such as age, sex, increased blood pressure, and whether there is evidence of coronary disease or diabetes. Necessarily, a considerable amount of information must be integrated to reach an appropriate decision. If treatment is decided, current practice is to measure or calculate all five lipid indices on each of the return visits. Again this information must be integrated to determine whether the therapy used has achieved the desired targets. Unfortunately, most patients do not reach their designated target lipid concentrations, although all the reasons for this fact have not been determined. One hypothesis that might partially explain this failure could be the complexity inherent in the present algorithm because both the patient and the doctor have to assimilate a considerable amount of information. If it were possible to reduce the number of indicators examined at follow-up after therapy had begun, the process might be more effectively executed.