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从美国指南中修改后的风险分层模型可以应用于有或没有ASCVD的亚洲人群:验证研究
Yu-Chung Hsiao1, Thung-Lip Lee2, Fang-Ju Lin3
1Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Biomedical journal
|August 14, 2023
概括
修改后的美国 (MUS) 模型有效预测亚洲患者的心血管事件,优于欧洲和日本模型. 管理层应该优先考虑背景风险因素,而不仅仅是预防策略.
科学领域:
- 心脏病学 心脏病学
- 公共卫生 公共卫生
- 流行病学 流行病学
背景情况:
- 心血管疾病 (CVD) 风险预测模型对于患者管理至关重要.
- 现有的模型可能无法准确地反映亚洲人等不同种族群体的风险.
- 根据2018年ACC/AHA脂质指南修改的美国 (MUS) 模型,需要在亚洲队列中进行验证.
研究的目的:
- 评估MUS模型对亚洲患者心血管 (CV) 事件风险预测的性能.
- 将MUS模型的预测准确度与已建立的欧洲和日本风险模型进行比较.
- 评估MUS模型在为初级和二级预防分层患者中的实用性.
主要方法:
- 利用来自两个多中心前性观察注册表队列 (T-SPARCLE和T-PPARCLE) 的数据进行验证.
- 采用了MUS模型,源自美国ACC/AHA 2018年脂质治疗指南.
- 将MUS模型的表现与使用主要不良心脏事件 (MACE) 为主要结果的欧洲和日本风险预测模型进行了比较.
主要成果:
- 该研究包括10,733名患者 (平均年龄为64.2岁,女性为36.5%),随访时间中位数为5.4年.
- MUS模型表现强,AUC为0.73 (95%CI为0.68-0.78),表现优于欧洲和日本模型 (AUC为0.6-0.7).
- 该MUS模型有效地将患者分为四个不同的风险组,具有显著的危险比率,表明整个类别的风险增加. 经过调整后,动脉样硬化血管疾病史在风险组内不是一个显著的预测因素.
结论:
- MUS模型是亚洲患者心血管风险分层的经过验证和有效工具,包括有或没有动脉样硬化血管疾病 (ASCVD) 的患者.
- 在预测主要不良心脏事件 (MACEs) 方面,MUS模型的性能与现有的欧洲和日本模型相比或更高.
- 临床管理策略应强调解决潜在的风险因素,而不是仅依赖初级或二级预防分类.
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