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
Jennifer S Lin1, Corinne V Evans1, Eric Johnson1
1Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon.
JAMA
|July 13, 2018
概括
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.
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.
相关概念视频
Factors Affecting the Risk of Infection
13.7K
The hosts' susceptibility to infection depends on several factors. The integrity of the skin and mucous membranes helps protect the body against microbial attacks. When the skin is altered, the chance of infection, limb loss, and even death increases.
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
13.7K
Relative Risk
2.2K
Relative risk (RR) is a statistical measure commonly used in epidemiology to compare the likelihood of a particular event occurring between two groups. This metric is important for evaluating the relationship between exposure to a specific risk factor and the probability of a particular outcome. It plays a crucial role in medical research, public health studies, and risk assessment. Relative risk quantifies how much more (or less) likely an event is to occur in an exposed group compared to an...
2.2K
Preventive Healthcare Services
2.2K
Preventive healthcare services keep people healthy via frequent check-ups, screening, and counseling. They primarily aid in disease prevention rather than treating an acute or chronic illness. Preventive treatment also keeps individuals productive and energetic, allowing them to work well into their retirement years. Examples of preventive care services include:
2.2K
Design Example: Analyzing Capacity Contours for Flood Risk Assessment
327
Flood risk assessment involves careful planning and analysis to ensure the safety of communities near water retention structures. Capacity contours are a vital tool in this process, as they illustrate the potential spread of water at specific levels in a given area. In the context of building a bund across a small valley, these contours play a critical role in evaluating the safety of nearby residential areas.In this example, the bund is intended to store stormwater in the valley. The engineers...
327
The Evidence for Evolution
48.3K
Genetic variations accumulating within populations over generations give rise to biological evolution. Evolutionary changes can result in the formation of novel varieties and entire new species. These changes are responsible for the diverse forms of life inhabiting the planet. The evidence for evolution suggests that all living organisms descended from common ancestors.
48.3K
Psychoneuroimmunology: Cardiovascular Disease
577
Psychoneuroimmunology (PNI) is a multidisciplinary field that examines how psychological factors, particularly stress, interact with the immune system and impact physical health. Research in PNI has shown that chronic or traumatic stress can disrupt both the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. These disruptions contribute to serious health conditions, including cardiovascular diseases.
A key area of focus in PNI is the relationship between stress and coronary...
A key area of focus in PNI is the relationship between stress and coronary...
577


