Value and Limitations of Existing Scores for the Assessment of Cardiovascular Risk A Review for Clinicians
Value and Limitations of Existing Scores for the Assessment of Cardiovascular Risk A Review for Clinicians
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DOI：
10.1016/j.jacc.2009.07.020
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发表时间：
2009-09-29
影响因子：
24
通讯作者：
Graham, Ian M.
中科院分区：
文献类型：
--
作者：
Cooney, Marie Therese;Dudina, Alexandra L.;Graham, Ian M.
动脉粥样硬化性心血管疾病（CVD）是全世界最大的死亡原因。对于大多数人来说，CVD 是许多因果危险因素的产物。几个看似不大的风险因素组合起来，可能会比一个令人印象深刻的单一因素带来更高的风险。因此，开发了风险评估系统来帮助临床医生评估风险因素组合在规划管理策略中的影响。在本文中，回顾了主要风险评估系统的性能。大多数在与用于派生该系统的人群相似的人群中表现良好，并且如果经过校准以允许不同的 CVD 死亡率和不同的危险因素分布，则在其他人群中表现良好。在年龄、性别、吸烟、血脂状况和血压中添加“新”风险因素的影响通常很小，但可能有助于将一些接近治疗阈值的患者适当地重新分类为更正确的“治疗/不治疗”类别。年轻人和老年人的风险评估需要更多的研究。仍然需要量化多重风险估计方法在改善结果方面的预期收益。但是，这种方法的广泛使用可能有助于解决治疗不足和过度治疗的问题。 （J Am Coll Cardiol 2009；54：1209-27）(C) 2009 年，美国心脏病学会基金会
Atherosclerotic cardiovascular diseases (CVDs) are the biggest causes of death worldwide. In most people, CVD is the product of a number of causal risk factors. Several seemingly modest risk factors may, in combination, result in a much higher risk than an impressively raised single factor. For this reason, risk estimation systems have been developed to assist clinicians to assess the effects of risk factor combinations in planning management strategies. In this article, the performances of the major risk estimation systems are reviewed. Most perform usably well in populations that are similar to the one used to derive the system, and in other populations if calibrated to allow for different CVD mortality rates and different risk factor distributions. The effect of adding "new" risk factors to age, sex, smoking, lipid status, and blood pressure is usually small, but may help to appropriately reclassify some of those patients who are close to a treatment threshold to a more correct "treat/do not treat" category. Risk estimation in the young and old needs more research. Quantification of the hoped-for benefits of the multiple risk estimation approach in terms of improved outcomes is still needed. But, it is likely that the widespread use of such an approach will help to address the issues of both undertreatment and overtreatment. (J Am Coll Cardiol 2009; 54: 1209-27) (C) 2009 by the American College of Cardiology Foundation