Estimating the population impact of screening strategies for identifying and treating people at high risk of cardiovascular disease: modelling study
Estimating the population impact of screening strategies for identifying and treating people at high risk of cardiovascular disease: modelling study
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DOI：
10.1136/bmj.c1693
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发表时间：
2010-04-25
影响因子：
105.7
通讯作者：
Griffin, Simon J.
中科院分区：
文献类型：
--
作者：
Chamnan, Parinya;Simmons, Rebecca K.;Griffin, Simon J.
目的根据英国政府推荐的筛查所有40-74岁成年人心血管风险的国家策略，评估不同筛查策略对识别和治疗心血管疾病高危人群的潜在人群影响，包括使用心血管风险分层常规数据的策略。设计模型研究使用前瞻性队列数据，EPIC-Norfolk（欧洲癌症-诺福克前瞻性调查）。背景：一个英国郡。参与者16970名男性和女性，年龄在40-74岁之间，基线时无心血管疾病和糖尿病。主要结局指标主要结局指标为人口归因分数、预防1例新发心血管疾病所需筛查的人数、预防1例新发心血管疾病所需治疗的人数以及可预防的新发心血管事件的数量。估计治疗效果的相对风险降低来自临床试验的荟萃分析或国家健康与临床卓越研究所的指南。结果随访183886人年，共发生1362例心血管事件。与推荐的政府策略相比，使用结合常规数据的简单风险评分的逐步筛查方法在英国每年可以预防相似数量的新心血管事件（分别为26789例、20778例至36239例）和25134例（分别为19450例至34134例），但只需要邀请60%的人口参加血管风险评估。通过邀请50-74岁的所有人进行血管评估，也可以预防类似数量的心血管事件（25 016,19 563至33 372）。使用参与者完成芬兰糖尿病风险评分问卷或人体测量分界点进行风险预分层效果较差。结论：与英国政府推荐的筛查所有40-74岁成年人心血管风险的国家策略相比，在邀请高风险人群进行血管风险评估之前，使用常规数据进行心血管风险分层的方法可能同样有效地预防心血管疾病的新病例，并可能节省成本。
Objective To estimate the potential population impact of different screening strategies for identifying and treating people at high risk of cardiovascular disease, including strategies using routine data for cardiovascular risk stratification, in light of the UK government's recommended national strategy to screen all adults aged 40-74 for cardiovascular risk.Design Modelling study using data from a prospective cohort, EPIC-Norfolk (European Prospective Investigation of Cancer-Norfolk).Setting An English county.Participants 16 970 men and women aged 40-74 and free from cardiovascular disease and diabetes at baseline.Main outcome measures The main outcomes were the population attributable fraction, the number needed to screen to prevent one new case of cardiovascular disease, the number needed to treat to prevent one new case of cardiovascular disease, and the number of new cardiovascular events that could be prevented. Relative risk reductions for estimated treatment effects were derived from meta-analyses of clinical trials or guidelines from the National Institute for Health and Clinical Excellence.Results 1362 cardiovascular events occurred over 183 586 person years of follow-up. Compared with the recommended government strategy, a stepwise screening approach using a simple risk score incorporating routine data could prevent a similar number (lower to upper estimates) of new cardiovascular events annually in the United Kingdom (26 789, 20 778 to 36 239) and 25 134 (19 450 to 34 134), respectively) but requiring only 60% of the population to be invited to attend a vascular risk assessment. A similar number of cardiovascular events (25 016, 19 563 to 33 372) could also be prevented by inviting everyone aged 50-74 for a vascular assessment. Using a participant completed Finnish diabetes risk score questionnaire or anthropometric cut-off points for risk prestratification was less effective.Conclusions Compared with the UK government's recommended national strategy to screen all adults aged 40-74 for cardiovascular risk, an approach using routine data for cardiovascular risk stratification before inviting people at high risk for a vascular risk assessment may be similarly effective at preventing new cases of cardiovascular disease, with potential cost savings.