2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
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DOI：
10.1016/j.jacc.2010.09.001
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发表时间：
2010-12-14
影响因子：
24
通讯作者：
Whitman, Gayle R.
中科院分区：
文献类型：
--
作者：
Greenland, Philip;Alpert, Joseph S.;Whitman, Gayle R.
本文件中列出的建议尽可能以证据为基础。对2008年3月至2010年4月期间进行了广泛的证据审查。这些研究仅限于在人类受试者中进行的研究、综述和其他证据，并以英文发表。关键检索词包括但不限于非裔美国人、亚裔美国人、白蛋白尿、无症状、无症状筛查和肱动脉反应性、动脉粥样硬化成像、房颤、肱动脉粥样硬化检测、校准、心脏断层扫描、顺应性、颈动脉内膜中层厚度（IMT）、冠状动脉钙、冠状动脉计算机断层扫描血管造影（CCTA）、C反应蛋白（CRP）、亚临床动脉粥样硬化的检测，辨别，内皮功能，家族史，血流介导的扩张，遗传学，遗传筛查，指南，西班牙裔美国人，血红蛋白A，糖基化，荟萃分析，墨西哥裔美国人，心肌灌注成像（MPI），无创检测，无创检测和2型糖尿病，结局，患者依从性，外周动脉张力测定（PAT），外周张力测定和动脉粥样硬化，脂蛋白相关磷脂酶A2，冠状动脉疾病（CAD）的一级预防，蛋白尿，心血管风险，风险评分，受试者工作特征（ROC）曲线，肱动脉反应性筛查，负荷超声心动图，亚临床动脉粥样硬化，亚临床和脆性，亚临床和多种族动脉粥样硬化研究（梅萨），和2型糖尿病。此外，编写委员会审查了ACCF和AHA、美国糖尿病协会（ADA）、欧洲心脏病学会和高血压预防、检测、评估和治疗联合国家委员会（JNC）7先前发表的与主题相关的文件。本文件中选择和发表的参考文献具有代表性，并非包罗万象。为向临床医生提供一套全面的数据，只要认为适当或在文章中发表时，将使用临床试验的数据来计算绝对风险差异和需要治疗或伤害的数量;还将提供与相对治疗效应相关的数据，如比值比（OR）、相对风险（RR）、风险比（HR）或发生率比（IRR），沿着置信区间（CI）（如可用）。本指南的重点是对表面健康的成年人发生动脉粥样硬化性血管疾病相关心血管事件的风险进行初步评估。这种对无症状个体心血管风险的早期评估的目的是根据该个体的预测风险为有针对性的预防工作提供基础。它基于长期以来的概念，即根据患者风险的严重程度来确定药物治疗干预的强度（2）。该临床方法是对人群预防心血管疾病（CVD）方法的补充，在人群预防中，无论个体风险如何，都使用人群策略。虽然没有明确的年龄临界点来定义CVD风险的发生，但在青少年和年轻人中可以检测到风险因素水平升高和亚临床异常。为了最大限度地发挥以预防为导向的干预措施的益处，特别是那些涉及生活方式改变的干预措施，编写委员会建议这些指南适用于20岁以上的无症状人群。委员会认为，关于一个…
The recommendations listed in this document are, whenever possible, evidence based. An extensive evidence review was conducted for the period beginning March 2008 through April 2010. Searches were limited to studies, reviews, and other evidence conducted in human subjects and published in English. Key search words included, but were not limited to, African Americans, Asian Americans, albuminuria, asymptomatic, asymptomatic screening and brachial artery reactivity, atherosclerosis imaging, atrial fibrillation, brachial artery testing for atherosclerosis, calibration, cardiac tomography, compliance, carotid intima-media thickness (IMT), coronary calcium, coronary computed tomography angiography (CCTA), C-reactive protein (CRP), detection of subclinical atherosclerosis, discrimination, endothelial function, family history, flow-mediated dilation, genetics, genetic screening, guidelines, Hispanic Americans, hemoglobin A, glycosylated, meta-analysis, Mexican Americans, myocardial perfusion imaging (MPI), noninvasive testing, noninvasive testing and type 2 diabetes, outcomes, patient compliance, peripheral arterial tonometry (PAT), peripheral tonometry and atherosclerosis, lipoprotein-associated phospholipase A2, primary prevention of coronary artery disease (CAD), proteinuria, cardiovascular risk, risk scoring, receiver operating characteristics (ROC) curve, screening for brachial artery reactivity, stress echocardiography, subclinical atherosclerosis, subclinical and Framingham, subclinical and Multi-Ethnic Study of Atherosclerosis (MESA), and type 2 diabetes. Additionally, the writing committee reviewed documents related to the subject matter previously published by the ACCF and AHA, American Diabetes Association (ADA), European Society of Cardiology, and the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) 7. References selected and published in this document are representative and not all-inclusive. To provide clinicians with a comprehensive set of data, whenever deemed appropriate or when published in the article, data from the clinical trial will be used to calculate the absolute risk difference and number needed to treat or harm; data related to the relative treatment effects will also be provided, such as odds ratio (OR), relative risk (RR), hazard ratio (HR), or incidence rate ratio (IRR), along with confidence interval (CI) when available. The focus of this guideline is the initial assessment of the apparently healthy adult for risk of developing cardiovascular events associated with atherosclerotic vascular disease. The goal of this early assessment of cardiovascular risk in an asymptomatic individual is to provide the foundation for targeted preventive efforts based on that individual’s predicted risk. It is based on the long-standing concept of targeting the intensity of drug treatment interventions to the severity of the patient’s risk (2). This clinical approach serves as a complement to the population approach to prevention of cardiovascular disease (CVD), in which population-wide strategies are used regardless of an individual’s risk.This guideline pertains to initial assessment of cardiovascular risk in the asymptomatic adult. Although there is no clear age cut point for defining the onset of risk for CVD, elevated risk factor levels and subclinical abnormalities can be detected in adolescents as well as young adults. To maximize the benefits of prevention-oriented interventions, especially those involving lifestyle changes, the writing committee advises that these guidelines be applied in asymptomatic persons beginning at age 20. The writing committee recognizes that the decision about a …