心脏热素和心血管疾病风险预测:个体参与者数据元分析
Anoop S V Shah1, Spencer J Keene2, Lisa Pennells3
1Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Cardiology, Imperial College NHS Trust, London, United Kingdom.
Journal of the American College of Cardiology
|April 9, 2025
概括
高灵敏性心脏托罗素 (hs-cTn) 适度改善心血管疾病 (CVD) 的预测. 将hs-cTn添加到危险因素中可以提高心血管疾病风险的重新分类,这可能有助于预防性他类药物治疗决策.
科学领域:
- 心脏病学 心脏病学
- 预防医学 预防医学
- 生物标志物研究 生物标志物研究
背景情况:
- 对于心血管疾病 (CVD) 的高灵敏性心脏托波宁 (hs-cTn) 的预测值需要进一步澄清.
- 现有的风险因素可能无法完全捕捉个人的心血管疾病风险概况.
研究的目的:
- 确定hs-cTn测量在预测事故心血管疾病方面的额外好处.
- 量化将hs-cTn纳入常规CVD风险评估模型的影响.
主要方法:
- 一个对15个队列的元分析,包括62,150名没有先前心血管疾病的参与者.
- 计算的危险比率 (HRs),风险歧视 (C指数) 和对心脏热素T (cTnT) 和心脏热素I (cTnI) 的重新分类 (净重新分类改进).
- 模拟使用英国发病率数据的他类药物治疗启动影响.
主要成果:
- 较高的hs-cTn水平 (cTnT/cTnI) 与心血管疾病风险增加显著相关 (HRs 1.31/1.26 per SD).
- 添加cTnT/cTnI改善了心血管疾病预测模型,使C指数增加了0.015/0.012,并在病例和非病例中重新分类风险.
- 根据风险重新分类,使用hs-cTn的查可以预防每408-473人开始使用他类药物治疗的1次心血管疾病事件.
结论:
- 测量hs-cTn在预测初发性心血管疾病方面提供了适度但显著的改进.
- 广泛使用hs-cTn测试可能会在预防心血管疾病方面带来大量的人口健康益处.
- Hs-cTn测试可以完善风险分层,指导更有效的预防干预措施,如他类药物治疗.
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