広範なスクリーニング前後の2型糖尿病における心血管リスクの予測:推論および検証研究
Romana Pylypchuk1, Sue Wells1, Andrew Kerr2
1School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Lancet (London, England)
|June 5, 2021
まとめ
ニュージーランド
科学分野:
- 心臓病科
- 内分泌学
- 公衆衛生
背景:
- 糖尿病患者の大半は 高い心血管リスクと診断され 予防的な治療が必要となります
- ニュージーランドの全国的なスクリーニングプログラムは,多くの無症状の糖尿病患者を特定しました.
- この変化は,検診された糖尿病集団の心臓血管リスク評価の更新を必要とします.
研究 の 目的:
- 広範な糖尿病スクリーニングの前に開発された心血管リスク予測方程式が,スクリーニングで検出された患者のリスクを過大評価するかどうかを評価する.
- 現代のスクリーニングで検出された2型糖尿病の5年間の心血管疾患リスクのための新しい性別方程式を開発し,検証する.
主な方法:
- 2型糖尿病の30歳から74歳の患者を含むPREDICTプライマリケアコホート研究 (n=46, 652) を利用した.
- 性別別別別のコックス回帰モデルが開発され,18の予測因子を用いて5年間の心血管疾患リスクが評価されました.
- 検診前のニュージーランド糖尿病コホート研究 (NZDCS) から得られた古い方程式に対する新しい方程式の性能の比較.
主要な成果:
- 新しい方程式は,古いNZDCS方程式 (14. 2% 女性, 17. 1% 男性) と比較して,より低い5年間の心血管リスクを推定した.
- 古いNZDCS方程式では 女性のリスクは3倍,男性のリスクは2倍まで高評価されていました.
- 新しいPREDICT方程式は,NZDCS方程式よりもモデルと差別のパフォーマンスを大幅に向上させました.
結論:
- ニュージーランドでは,広範囲にわたる糖尿病のスクリーニングにより,心血管疾患のリスクが異なる異質な集団が特定されました.
- 既存の心血管リスク予測方程式では,特に腎臓機能が正常な患者でのリスクが過大評価されています.
- 糖尿病と腎臓機能の予測因子を含めたリスク予測方程式の更新は,適切な患者管理とリソースの配分に不可欠です.
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