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心血管疾病风险评估中的非传统风险因素:美国预防服务工作组的最新证据报告和系统审查

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非传统风险因素如ABI,hsCRP和CAC得分可以改善心血管疾病风险评估,但需要更多的临床试验来确认它们对患者的结果的影响.

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科学领域:

  • 心脏病学
  • 预防医学
  • 医疗诊断

背景情况:

  • 传统的心血管疾病风险评估模型可以通过结合非传统风险因素来增强.
  • 美国预防服务工作组 (USPSTF) 要求对潜在干预措施的益处和危害进行系统审查.

研究的目的:

  • 在心血管风险评估中系统地审查使用脚-手臂指数 (ABI),高灵敏性C反应蛋白 (hsCRP) 水平和冠状动脉 (CAC) 评分的益处和危害的证据.
  • 评估这些非传统风险因素对风险评估绩效措施的影响.

主要方法:

  • 对2018年2月之前发表的研究进行了MEDLINE,PubMed和Cochrane控制试验中心注册的系统审查.
  • 包括的研究集中在没有已知的心血管疾病的无症状成年人.
  • 数据抽象和批判性评估是由两个审查者独立进行的.

主要成果:

  • 其中包括了43项研究,共267244名参与者. 没有足够强大的试验评估了这些因素对患者健康结果的临床影响.
  • 增加了ABI,hsCRP或CAC分数,以不同的一致性和规模改善了歧视和重新分类.
  • CAC评分显示在歧视和重新分类方面取得了最大的改善,但也指出了不适当的风险重新分类的可能性. 危害仅限于CAC评分的低辐射暴露.

结论:

  • 没有足够的临床试验证据来评估ABI,hsCRP或CAC得分对风险评估和预防治疗的增量影响.
  • 如校准,区分和重新分类等风险预测措施的改善的临床意义仍然不确定.