心血管风险评估工具对于代谢功能障碍相关的脂肪性肝病患者来说是不够的
A Sidney Barritt1, Elliot B Tapper2, Philip N Newsome3
1UNC Liver Center, University of North Carolina, Chapel Hill, North Carolina.
The American journal of gastroenterology
|June 11, 2025
概括
像FRS和PCE这样的心血管风险得分在患有MASLD的患者中表现不佳. 需要新的工具来准确评估这一群体的心血管事件风险.
科学领域:
- 心脏病学 心脏病学
- 肝病学 肝病学是一种肝病学.
- 公共卫生 公共卫生
背景情况:
- 心血管 (CV) 事件风险通常使用弗雷明汉风险评分 (FRS),聚合队列方程 (PCE) 和AHA PREVENT方程进行估计.
- 这些已建立的风险评估工具在患有代谢功能障碍相关性肝病 (MASLD) 的患者中的准确性仍然不确定.
研究的目的:
- 评估FRS,PCE和PREVENT在现实世界MASLD队列中的5-10年CV事件的预测准确度.
- 评估这些风险预测模型在MASLD群体中的校准和歧视.
主要方法:
- 从TARGET-NASH研究中对患有MASLD的美国成年人 (≥30岁) 的分析.
- 使用原始和重新校准的FRS和PCE以及原始PREVENT方程,估计心血管风险.
- 模型歧视 (C-统计) 和校准 (霍斯默-莱梅斯霍夫测试) 的评估.
主要成果:
- 弗雷明汉风险评分 (FRS) 显示预测能力较弱 (C统计值为0.58).
- AHA PREVENT模型也显示了有限的歧视 (C统计值为0.60).
- 无论是FRS还是PCE都表现出重大校准问题,高风险组的风险被高估,低风险组的风险被低估.
结论:
- 标准的心血管风险预测工具对于患有MASLD的患者来说是不够的.
- 需要改进风险评估策略,以应对MASLD患者心血管事件的高死亡率.
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