米国予防サービスタスクフォースの勧告とACC/AHAのガイドラインに基づいて,プライマリ予防スタチンの適格性の比較
Neha J Pagidipati1, Ann Marie Navar1, Hillary Mulder1
1Duke Clinical Research Institute, Duke University, Durham, North Carolina.
JAMA
|April 19, 2017
まとめ
主要予防におけるスタチン療法に関する新しい米国のガイドラインは,古いACC/AHAガイドラインと比較して,治療を受ける人を少なくすることを推奨する可能性があります. これは心臓血管疾患のリスクが高い若い成人に影響を与える可能性があります.
科学分野:
- 心血管医学
- 予防的な心臓病
- 公衆衛生に関するガイドライン
背景:
- 主要予防におけるスタチン療法に関するガイドラインの推薦は,有意な違いを示しています.
- 米国予防サービスタスクフォース (USPSTF) は,現在,心血管疾患 (CVD) リスク因子に基づく治療と,10年間の全世界のCVDリスク10%以上を強調しています.
研究 の 目的:
- 2016年のUSPSTFの勧告と2013年のAmerican College of Cardiology/American Heart Association (ACC/AHA) のガイドラインに基づいて,米国の成人のプライマリ予防スタチン治療の適格性を比較する.
主な方法:
- 米国で40歳から75歳までの3416人の代表的なサンプルから得られた国家健康栄養調査 (NHANES) のデータ (2009年−2014年) を利用した.
- 2016年のUSPSTFの勧告と2013年のACC/AHAのコレステロールガイドラインに基づいてスタチンの適格性を評価した.
主要な成果:
- USPSTFの勧告の完全な実施は,ACC/ AHAのガイドラインの24. 3%と比較して,さらに15. 8%の患者でスタチン投与を開始する.
- ACC/AHAが推奨した,しかしUSPSTFが推奨しなかった顕著なグループ (8. 9%) には,長期的なCVDリスクが高い (40-59歳) と糖尿病を有する個人が含まれていた.
結論:
- 2016年のUSPSTFの勧告は,2013年のACC/AHAのガイドラインと比較して,小児予防スタチン治療を推奨される人が少なくなる可能性がある.
- この推薦の差異は,特に長期的な心血管疾患のリスクが高い若い成人に影響を及ぼす可能性があります.
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