医生对心血管风险评估和LDL胆固醇目标确定的知识和实践:一个单心横截面调查
Giovanni Orecchio1, Sylvain Le Jeune2, Antonio Morabito2
1Università degli studi dell'Insubria, Varese, 21100 Lombardia, Italy; Vascular Internal Medicine, Avicenne Hospital, University Paris Sorbonne Paris Nord, 93000 Bobigny, France.
Vascular diseases (Paris, France)
|February 28, 2026
概括
临床医生在评估心血管风险方面表现出显著的不确定性,经常低估了诸如动脉样硬化心血管疾病 (ASCVD) 和慢性病 (CKD) 等疾病的风险. 这突显了指导方针与实践之间的差距,需要教育干预措施来改善患者护理.
科学领域:
- 心脏病学 心脏病学
- 预防医学 预防医学
- 临床实践研究 临床实践研究
背景情况:
- 心血管疾病 (CVD) 是全球主要的死亡原因.
- 失脂症是心血管疾病的一个主要可修改的风险因素.
- 精确的心血管 (CV) 风险分层对于管理低密度脂蛋白胆固醇 (LDL-C) 和预防心血管疾病至关重要,但临床实践显示出显著的变化.
研究的目的:
- 在阿维森纳大学医院的临床医生中评估心血管风险评估和LDL-C目标选择的一致性和准则的遵守.
- 在复杂的临床场景中评估临床医生的表现,在这种情况下,标准风险计算器可能不足.
主要方法:
- 从9月到2025年11月,在阿维森纳大学医院进行了一项横截面调查.
- 来自五个部门的30名医生和住院医生参加了这次会议,他们对六个临床细节做出了回应.
- 响应被按心血管风险 (低至极端) 分类,根据与2025年ESC/EAS失脂症指南一致的建议LDL-C目标.
主要成果:
- 观察到响应中存在显著的异质性,其中"没有类别"是最常见的响应 (29.4%),表明临床医生的不确定性很大.
- 在心力衰竭后的风险分配中,注意到高不确定性 (43.3%"没有类别").
- 在确诊的动脉样硬化心血管疾病 (ASCVD) 中发现了低估风险,不愿意将"极端风险"类别用于复发事件,并且不充分地将中度慢性病 (CKD) 视为高风险.
结论:
- 目前的CV风险评估指南与临床实践之间存在着显著的差距.
- 临床医生倾向于低估ASCVD和CKD的风险,并在诸如心力衰竭和复发性事件等复杂病例中表现出不确定性.
- 需要有针对性的教育举措,以改善符合指导方针的CV风险分层,并优化预防疗法.
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