根据AHA的PREVENT心血管风险方程,预计静脉类药物和抗高血压疗法的适用性变化
James A Diao1,2, Ivy Shi1,3, Venkatesh L Murthy4
1Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts.
JAMA
|July 29, 2024
概括
新的PREVENT方程可能会降低数百万人的动脉样性心血管疾病 (ASCVD) 风险得分,从而可能降低他类药物和抗高血压治疗的适用性. 这种变化可能会导致10年内增加107,000例心脏病发作或中风.
科学领域:
- 心血管医学
- 公共卫生
- 流行病学
背景情况:
- 目前美国心脏病学会 (ACC) 和美国心脏协会 (AHA) 的指导方针使用聚合队列方程 (PCE) 来估计动脉样硬化心血管疾病 (ASCVD) 的风险.
- 新的预测心血管疾病风险 (PREVENT) 方程提供了改进的校准,并纳入脏测量,消除了种族作为一个因素.
- PREVENT 方程的预测 ASCVD 风险低于 PCE,因此需要对其临床影响进行评估.
研究的目的:
- 根据目前的ACC/AHA指南,量化应用PREVENT方程对美国成年人的风险分类和治疗资格的影响.
- 估计他类药物和抗高血压药物的适用性变化.
- 预测临床结果的潜在变化,如心肌梗塞和中风.
主要方法:
- 来自国家健康和营养检查调查 (2011-2020年) 的7765名美国成年人的全国代表样本的分析.
- 使用PREVENT和PCE方程进行ASCVD风险预测,风险类别和治疗资格的比较.
- 基于治疗资格变化的预计心肌梗塞和中风发生率的估计.
主要成果:
- 在PREVENT方程中,53.0%的成年人被重新分类到较低的ASCVD风险类别,只有0.41%被转移到更高的类别.
- 估计有1430万的成年人将有资格接受他类药物治疗,还有262万的成年人将有资格接受抗高血压治疗.
- 这些治疗资格的减少可能会导致10年内约107,000例心肌梗塞或中风,不成比例地影响男性和黑人成年人.
结论:
- 应用PREVENT方程式与现有的ACC/ AHA治疗值可能会降低美国1580万成年人接受他类药物和抗高血压治疗的资格.
- 这些发现突出了采用PREVENT方程的潜在显著临床影响,包括增加主要心血管不良事件的风险.
- 根据不断发展的ASCVD风险评估工具,需要进一步研究以完善风险预测模型并确保最佳的患者护理.
更多相关视频
相关概念视频
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
413
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
413
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
539
Accurate blood pressure assessment is crucial for diagnosing and managing various health conditions. To ensure the reliability of these measurements, healthcare professionals must adhere to standardized pre-procedural guidelines. These guidelines enhance patient safety and improve the overall quality of healthcare. The following steps are essential for obtaining accurate and consistent blood pressure readings, from using the appropriate tools to ensuring effective communication with the...
539
01:23Assessment of the Cardiovascular System I: Subjective Data
293
A thorough health history and physical assessment are essential for identifying cardiovascular disease (CVD) symptoms and distinguishing them from other health issues.
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
293
01:20Exercise and Cardiovascular Response
765
Exercise significantly impacts cardiovascular response, which is crucial for understanding patient health and designing effective treatment plans.
Light to moderate physical activity initiates a series of interconnected responses in the body. The heart rate modestly increases in anticipation of the workout, followed by widespread vasodilation as oxygen consumption by skeletal muscles increases. This results in decreased peripheral resistance, increased capillary blood flow, and accelerated...
Light to moderate physical activity initiates a series of interconnected responses in the body. The heart rate modestly increases in anticipation of the workout, followed by widespread vasodilation as oxygen consumption by skeletal muscles increases. This results in decreased peripheral resistance, increased capillary blood flow, and accelerated...
765
01:18Cardiovascular Drugs: Classification based on Therapeutic Indications
2.2K
Cardiovascular diseases, encompassing a range of conditions, can significantly affect the heart's operations and the overall circulatory system. These conditions impair the heart's ability to pump blood, leading to a deficit in oxygen supply to crucial organs. Anomalies in the heart's electrical system, known as arrhythmias, can cause heartbeats to accelerate or slow down. Usually, heart rates increase during physical activity and decrease while resting or sleeping. However,...
2.2K