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对冠心病的主要危险因素的量化重要性
Michael J Pencina1, Ann Marie Navar1, Daniel Wojdyla1
1Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.J.P., A.M.N., D.W., E.D.P.).
Circulation
|December 28, 2018
概括
控制高血压和胆固醇等关键冠状动脉疾病 (CHD) 风险因素显著减少了CHD事件,尽管它们对预后模型的增加很小. 定制风险因素评估对于有效的预防策略至关重要.
科学领域:
- 心血管疾病研究
- 预防医学
- 流行病学
背景情况:
- 优化冠心病 (CHD) 预防需要量化关键风险因素的影响.
- 可修改的危险因素包括脂质,静脉压 (SBP),糖尿病和吸烟.
研究的目的:
- 将可修改的冠状动脉疾病风险因素与发生的冠状动脉疾病事件的关联进行比较.
- 根据年龄来评估预后性能,可归因的风险分数和治疗益处.
主要方法:
- 利用国家心脏,肺和血液研究所观察队列研究的参与者级数据.
- 包括22,626名最初没有心血管疾病的45-84岁的个体,持续跟踪10年.
- 使用比例危险回归来估计模型性能,危险比率和可归因于人口的分数.
主要成果:
- 年龄,性别和种族解释了预后表现的63-80%;添加SBP,非HDL-C,糖尿病或吸烟产生了轻微的增加 (C指数为0.004-0.013).
- 对于SBP≥130mmHg,可归因于人群的分数为28%,而非HDL-C≥130mg/dL则为17%.
- 将SBP降低到<130 mm Hg或LDL- C,可使10年内心脏病的风险分别降低3. 7%和2. 7%;风险降低随着年龄的增长而增加.
结论:
- 个别可修改的冠状动脉疾病风险因素对预后影响很小,但在人口水平上具有很大的预防潜力.
- 控制SBP和非HDL-C可以显著减少总体心血管疾病事件.
- 风险因素评估指标应与有效预防心血管疾病的具体研究目标保持一致.
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