对非传统风险因素的心血管疾病的风险评估:美国预防服务工作组建议声明
, Susan J Curry1, Alex H Krist2,3
1University of Iowa, Iowa City.
JAMA
|July 13, 2018
概括
在心血管疾病 (CVD) 风险模型中添加非传统的风险因素,如ABI,hsCRP和CAC,显示了微小的改善,但缺乏明确的临床意义. 需要更多证据来评估它们在预防心血管疾病方面的益处.
科学领域:
- 心脏病学
- 预防医学
- 健康风险评估
背景情况:
- 心血管疾病 (CVD) 是美国的主要死亡原因.
- 目前的心血管疾病风险评估模型,如弗雷明汉风险评分和聚合队列方程,指导预防性治疗.
- 通过结合其他因素来改善风险评估,可以提高治疗的向性和结果.
研究的目的:
- 更新使用非传统风险因子进行冠心病风险评估的建议.
- 评估将非传统风险因素添加到现有的心脏病风险模型的影响.
主要方法:
- 对脚-手臂指数 (ABI),高灵敏性C反应蛋白 (hsCRP) 和冠状动脉 (CAC) 评分的证据进行系统审查.
- 以这些非传统因素为指导的风险评估和治疗的益处和危害的评估.
- 对模型校准,区分和风险重新分类的改进进行评估.
主要成果:
- 将ABI,hsCRP和CAC分数添加到现有模型中显示出差别和风险重新分类的微小改善,但临床意义尚不清楚.
- 将这些因素添加到聚合队列方程的证据有限.
- 没有足够的证据来确定这些添加剂是否减少心血管疾病事件或死亡率.
- 与早期发现和干预相关的危害发现很小.
结论:
- 目前的证据不足以确定在无症状成年人心血管疾病风险评估中使用ABI,hsCRP或CAC得分的益处和危害平衡.
- 美国预防服务工作组 (USPSTF) 发布了一份"I"声明,指出证据不足.
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