Reply: Understanding Myocardial Infarction in Young Individuals Now or in 30 Years?
Reply: Understanding Myocardial Infarction in Young Individuals Now or in 30 Years?
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回复：现在或30年后了解年轻人心肌梗塞？
DOI：
10.1016/j.jacc.2023.06.018
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发表时间：
2023
影响因子：
24
通讯作者：
Reynolds,Kristi
中科院分区：
文献类型：
--
作者：
An,Jaejin;Zhang,Yiyi;Moran,AndrewE;Reynolds,Kristi
我们感谢Zeitouni博士及其同事对我们关于年轻人动脉粥样硬化性心血管疾病（ASCVD）发病率的研究的评论。1我们研究的一个重要发现是，在中位数为4年的随访中，当预测年轻成人ASCVD发病率时，30年与10年风险模型的重新分类更好。有几个原因可以解释我们的发现。首先，尽管10年和30年风险模型都包括类似的传统风险因素列表，但10年风险模型是在40岁的成年人中开发的。而30年模型包括大约60%的20至39岁的年轻人。其次，由于年龄是10年风险模型中ASCVD风险的主要驱动因素，因此即使存在传统风险因素，年轻人的10年预测风险也较低。我们的研究结果表明，与具有低10年和30年风险的年轻人相比，具有低预测10年风险但30年风险升高的年轻人的ASCVD发病率高3倍，证实了30年风险模型有助于识别风险年轻人，正如2018年美国心脏协会/美国心脏病学院胆固醇指南所建议的那样。重要的是，了解长期ASCVD风险将有助于年轻人避免错误的安全感，并鼓励在年轻时开始改变生活方式。尽管我们强调了长期风险评估工具在年轻人中的价值，但我们同意Zeitouni博士及其同事关于当前ASCVD风险模型的局限性。在我们的研究中，在50岁之前发生ASCVD的年轻人中，只有5.2%和10.6%的10年和30年风险升高，
We thank Dr Zeitouni and colleagues for their comments regarding our study on the incidence of atherosclerotic cardiovascular disease (ASCVD) in young adults. 1 An important finding of our study was the better reclassification of 30-year vs 10-year risk models when predicting ASCVD incidence in young adults during a median of 4 years of follow-up. Several reasons may explain our findings. First, although both 10-year and 30-year risk models include a similar list of traditional risk factors, the 10-year risk model was developed in adults aged $40 years. whereas the 30-year model included approximately 60% of young adults aged 20 to 39 years. 2 Second, because age was the primary driver of ASCVD risk in the 10-year risk model, young adults had a low predicted 10-year risk, even in the presence of traditional risk factors. Our findings showed that young adults with a low predicted 10-year risk but an elevated 30-year risk had a 3-fold higher ASCVD incidence compared with those with both low 10-year and 30-year risks, confirming that 30-year risk models are helpful for identifying at-risk young adults, as recommended by the 2018 American Heart Association/American College of Cardiology cholesterol guidelines. Importantly, knowing longer term ASCVD risk will help young adults to avoid the false sense of security with low predicted 10-year risk and encourage the initiation of lifestyle modifications at a younger age.Although we highlight the values of longer term risk assessment tools in young adults, we agree with Dr Zeitouni and colleagues on the limitations of current ASCVD risk models. In our study, only 5.2% and 10.6% of young adults who developed ASCVD before age 50 years had elevated 10-year and 30-year risk,
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