Calibration of the Pooled Cohort Equations for Atherosclerotic Cardiovascular Disease An Update
Calibration of the Pooled Cohort Equations for Atherosclerotic Cardiovascular Disease An Update
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DOI：
10.7326/m16-1739
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发表时间：
2016-12-06
影响因子：
39.2
通讯作者：
Ridker, Paul M.
中科院分区：
文献类型：
--
作者：
Cook, Nancy R.;Ridker, Paul M.
美国心脏病学会和美国心脏协会于2013年秋季发布的最新指南，对美国国家胆固醇教育计划专家小组(成人治疗小组III)第三份报告中的建议进行了期待已久的更新。该指南纳入了包括中风和冠心病在内的动脉粥样硬化性心血管疾病的新风险评分。发表后，新的集合队列方程(PCE)在来自美国和欧洲的15项研究中进行了评估，其中大多数使用的队列比制定指南时使用的队列更当代。在几乎所有这些外部验证队列中，PCE高估了观察到的风险。这一叙述性审查提供了已发表报告的最新情况，概述了这些验证工作的优点和缺点，并讨论了出现差异的可能原因。这些问题可能在重新校准过程中有用，该过程旨在更好地匹配与当前临床实践相关的预测和观察到的风险。
The latest guidelines from the American College of Cardiology and American Heart Association, released in fall 2013, provide a long-anticipated update to the recommendations of the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). The guidelines incorporate a new risk score for atherosclerotic cardiovascular disease that includes stroke as well as coronary heart disease. After publication, the new pooled cohort equations (PCEs) were evaluated in 15 studies from the United States and Europe, most of which used cohorts that were more contemporary than those used in developing the guidelines. In almost all of these external validation cohorts, the PCEs overestimated the observed risk. This narrative review provides an update of the published reports, an overview of the strengths and weaknesses of these validation efforts, and a discussion of possible reasons for the discrepancies. These issues may be useful in a recalibration process designed to better match predicted and observed risks relevant for current clinical practice.