Implications of the US cholesterol guidelines on eligibility for statin therapy in the community: comparison of observed and predicted risks in the Framingham Heart Study Offspring Cohort.
Implications of the US cholesterol guidelines on eligibility for statin therapy in the community: comparison of observed and predicted risks in the Framingham Heart Study Offspring Cohort.
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DOI：
10.1161/jaha.115.001888
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发表时间：
2015-04-17
影响因子：
5.4
通讯作者：
Vasan RS
中科院分区：
文献类型：
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作者：
Andersson C;Enserro D;Larson MG;Xanthakis V;Vasan RS
有人担心 2013 年动脉粥样硬化性心血管疾病 (ASCVD) 风险估计器高估了当代人群的风险。次优校准是否会导致他汀类药物过度治疗尚不清楚。我们根据 2013 年胆固醇指南，调查了弗雷明汉心脏研究后代队列中符合他汀类药物治疗条件的人数，并估计了由于 ASCVD 估计器潜在校准错误而可能过度治疗的比例。在中位随访 10 年期间，我们观察到 3396 名男性中有 285 起 ASCVD 事件（8.4%；包括缺血性中风、心肌梗死和冠状动脉疾病死亡），3838 名女性中有 112 起事件（2.9%）。 Hosmer-Lemeshow 卡方统计数据显示，男性为 16.3（预测事件为 340 个，观察事件为 285 个），女性为 29.1（预测事件为 166 个，观察事件为 112 个）。过度预测主要发生在风险最高十分位的女性和≥7 风险十分位的男性中，观察到的 ASCVD 事件发生率≥7.5%。根据新指南，共有 2615 名参与者（36%；867 名女性）有资格接受他汀类药物治疗。其中，171 名女性 (20%) 和 154 名男性 (9%) 使用重新校准的 ASCVD 估计器被向下重新分类（因为不符合他汀类药物治疗的条件）。在后一组中，18 名女性（10.5%；95% CI 5.9% 至 15.2%）和 11 名男性（7.1%；95% CI 3.0% 至 11.3%）经历了 ASCVD。风险估计者高估了 ASCVD 风险，但主要是在高风险参与者中，无论如何，他们都被认为有资格使用他汀类药物。我们的研究结果可能会减轻人们对当代队列中 ASCVD 估计器校准错误的潜在影响的担忧。
Concerns have been raised that the 2013 atherosclerotic cardiovascular disease (ASCVD) risk estimator overpredicts risk in contemporary cohorts. Whether suboptimal calibration will lead to overtreatment with statins is unknown. We investigated the numbers of people eligible for statin treatment in the Framingham Heart Study Offspring Cohort, based on the 2013 cholesterol guidelines, and estimated the proportion that may be overtreated as a result of potential miscalibration of the ASCVD estimator. During a median follow‐up of 10 years, we observed 285 ASCVD events (8.4%; comprising ischemic stroke, myocardial infarction, and coronary artery disease death) among 3396 men and 112 events (2.9%) among 3838 women. Hosmer–Lemeshow chi‐square statistics were 16.3 in men (340 predicted versus 285 observed events) and 29.1 in women (166 predicted versus 112 observed events). Overprediction predominantly occurred among women in the highest risk decile and among men in the ≥7th risk deciles, for which observed ASCVD event rates were ≥7.5%. In total, 2615 participants (36%; 867 women) were eligible for statins based on the new guidelines. Of these, 171 women (20%) and 154 men (9%) were reclassified downward (as not eligible for statin therapy) using a recalibrated ASCVD estimator. In the latter group, 18 women (10.5%; 95% CI 5.9% to 15.2%) and 11 men (7.1%; 95% CI 3.0% to 11.3%) experienced ASCVD. The risk estimator overpredicted ASCVD risk but did so mainly among high‐risk participants who would be considered eligible for statin use anyway. Our findings may mitigate concerns regarding the potential impact of miscalibration of the ASCVD estimator in contemporary cohorts.