在广泛查之前和之后的2型糖尿病心血管风险预测:推导和验证研究
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
概括
新西兰
科学领域:
- 心脏病学
- 内分泌学
- 公共卫生
背景情况:
- 全球大多数糖尿病患者被诊断为患有高心血管风险,需要预防性药物治疗.
- 新西兰国家查计划发现了许多无症状的糖尿病患者.
- 这种转变需要对查检测到的糖尿病人群进行更新的心血管风险评估.
研究的目的:
- 评估在广泛的糖尿病查之前开发的心血管风险预测方程是否高估了查发现的患者的风险.
- 在当代2型糖尿病检测队列中开发和验证5年心血管疾病风险的新的性别特异方程.
主要方法:
- 使用了PREDICT初级保健队列研究 (n=46,652),包括30至74岁的2型糖尿病患者.
- 使用18个预测因素开发了针对5年心血管疾病风险的性别特异性考克斯回归模型.
- 新方程式与先前查新西兰糖尿病队列研究 (NZDCS) 中的旧方程式的性能比较.
主要成果:
- 与较旧的NZDCS方程 (14. 2% 女性, 17. 1% 男性) 相比,新的方程估计了较低的5年心血管风险 (女性4. 0%,男性7. 1%).
- 旧的NZDCS方程高估了女性的风险高达三倍,男性的风险高达两倍.
- 新的PREDICT方程显示出比NZDCS方程更好的模型和歧视性能.
结论:
- 新西兰广泛开展的糖尿病查发现了不同心血管风险的不同人群.
- 现有的心血管风险预测方程高估了查检测的患者的风险,特别是具有正常功能的患者.
- 有关糖尿病和功能预测指标的最新风险预测方程对于适当的患者管理和资源分配至关重要.
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