Black-White Cardiovascular Disease Disparities After Target-Based Versus Personalized Benefit-Based Lipid and Blood Pressure Treatment.
Black-White Cardiovascular Disease Disparities After Target-Based Versus Personalized Benefit-Based Lipid and Blood Pressure Treatment.
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DOI：
10.1177/2381468317725741
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发表时间：
2017-07
影响因子：
--
通讯作者：
Hayward RA
中科院分区：
文献类型：
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作者：
Basu S;Sussman JB;Hayward RA
背景：心血管疾病（CVD）仍然是美国黑人和白人发病率和死亡率差异的主要原因。目的：我们试图比较黑白两组CVD的发病率和死亡率，如果脂质和血压治疗是为了达到目标的脂质和血压水平（治疗到目标[TTT]）或个性化的CVD风险和治疗效益估计（基于效益的量身定制治疗[BTT]）。方法：我们利用基于TTT方法（联合国家委员会7；成人治疗小组III）或BTT方法（治疗10年心血管疾病风险≥10%的患者，这是最近美国心脏病学会/美国心脏协会指南的修改和扩展）的他汀类药物和血压治疗的微观模拟模型。我们输入来自全国健康和营养调查的数据，隔离40至75岁没有心血管疾病事件的成年人。结果：我们观察到TTT比BTT方法预防更少的心血管疾病事件（每1000名白人预防17.0起事件，每1000名黑人预防22.2起事件）（每1000名白人预防25.9起事件，每1000名黑人预防45.4起事件）。TTT可以将全国黑人-白人心血管疾病事件发生率差异从每1000名黑人23.1例超额事件降低到17.9例超额事件（- 23%），而BTT可以将差距降低到3.6例超额事件（总体- 84%）。在测试替代治疗靶点的敏感性分析和常用方程对风险的高估或低估中，TTT对BTT的劣效性保持一致。结论：与传统的TTT方法相比，BTT治疗血脂和血压的方法有望在总体人群中预防更多的CVD事件，并更有效地减少国家黑白CVD差异。
Background: Cardiovascular disease (CVD) remains the leading cause of black-white morbidity and mortality disparities in the United States. Objectives: We sought to compare black-white CVD morbidity and mortality if lipid and blood pressure treatments were prescribed to achieve targeted lipid and blood pressure levels (treat-to-target [TTT]) or personalized CVD risk and treatment benefit estimates (benefit-based tailored treatment [BTT]). Methods: We utilized a microsimulation model of statin and blood pressure treatment based on a TTT approach (Joint National Commission 7; Adult Treatment Panel III) or a BTT approach (treating those with 10-year CVD risk ≥10%, a modification and extension of recent American College of Cardiology/American Heart Association guidelines). We input data from the National Health and Nutrition Examination Survey, isolating adults 40 to 75 years of age without prior CVD events. Results: We observed that TTT would prevent fewer CVD events (17.0 events prevented per 1,000 whites, 22.2 per 1,000 blacks) than the BTT approach (25.9 events prevented per 1,000 whites, 45.4 per 1,000 blacks). TTT could lower the national black-white CVD event rate disparity from 23.1 excess events per 1,000 blacks to 17.9 excess events (−23%), while BTT could lower the disparity to 3.6 excess events (−84% overall). The inferiority of TTT to BTT remained consistent in sensitivity analyses testing alternative treatment targets and either over- or underestimation of risk by commonly used equations. Conclusions: A BTT approach to lipid and blood pressure treatment would be expected to prevent more CVD events in the overall population and more effectively reduce national black-white CVD disparities than a traditional TTT approach.