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用PREVENT和PCE模型来估计ASCVD风险,根据他类药物暴露分层
Ming-Sum Lee1, James Onwuzurike1, Yi-Lin Wu2
1Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
JAMA network open
|September 16, 2025
概括
预防方程低估了不服用他类药物的患者的心血管风险,而聚合队列方程 (PCE) 更好地估计了没有他类药物治疗的风险. 这两种模型在预测动脉样硬化心血管疾病 (ASCVD) 事件方面表现相似.
科学领域:
- 心脏病学 心脏病学
- 预防医学 预防医学
- 医疗信息学 医疗信息学
背景情况:
- 心血管疾病事件预测风险 (PREVENT) 方程旨在改善10年动脉样硬化心血管疾病 (ASCVD) 风险估计,而不是聚合队列方程 (PCE).
- 这些风险计算器对于指导他类药物治疗决策至关重要,但可能无法完全考虑在随访期间使用他类药物.
- 准确的ASCVD风险评估对于初级预防策略至关重要.
研究的目的:
- 评估PREVENT和PCE方程在估计10年ASCVD风险中的性能.
- 具体评估随访期间他类药物暴露如何影响这些风险预测模型的准确性.
- 为了比较观察到的ASCVD事件率与不同他类药物暴露层的两个方程估计的风险.
主要方法:
- 一个回顾性队列研究,利用综合医疗保健系统的10年随访数据.
- 包括没有先前存在的糖尿病或ASCVD的成年人,在2013年确定.
- 将PREVENT和PCE估计的ASCVD风险与观察到的事件ASCVD事件进行比较,使用C统计评估的歧视,按他类药物暴露分层.
主要成果:
- 该研究包括193,885名成年人,其中6,528人经历了ASCVD事件. 无论是PCE (C统计:0.725) 还是PREVENT (C统计:0.723) 都表现出类似的歧视.
- 总的来说,观察到的10年ASCVD风险低于PCE估计的,但与PREVENT估计更加一致.
- 在没有暴露于他类药物的患者中,PREVENT显著低估了风险,而PCE估计更准确地反映了观察到的风险.
结论:
- 预防模型低估了未接受他类药物治疗的个体的ASCVD风险.
- 在没有使用他类药物治疗的情况下,PCE模型提供了更接近患者风险的估计值.
- 对他类药物暴露的准确核算对于完善ASCVD风险预测模型和临床决策至关重要.
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