Fewer patients receive recommendations for pharmacotherapy in primary prevention using the 2018 atherosclerotic cardiovascular disease risk estimator.
Fewer patients receive recommendations for pharmacotherapy in primary prevention using the 2018 atherosclerotic cardiovascular disease risk estimator.
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DOI：
10.1016/j.ypmed.2021.106555
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发表时间：
2021-07
影响因子：
5.1
通讯作者：
Dorsch MP
中科院分区：
文献类型：
--
作者：
Campos-Staffico AM;Cordwin D;Ding Y;Lester CA;Brook RD;Luzum JA;Dorsch MP
在引入2013年最初的集合队列方程(PCE)后不久，有人建议高估风险。因此，更新的2018年PCE是为了更准确地评估人群中的动脉粥样硬化性心血管疾病(ASCVD)风险。因此，这项研究旨在比较大量真实患者群体中的药物处方建议，这取决于使用哪种PCE来估计10年的ASCVD风险。这项回顾性队列研究确定了20,843名年龄在40岁至75岁之间、没有ASCVD病史的患者。使用两种PCE评估10年ASCVD风险评分。根据2018年ACC/AHA指南，患者被分配到四个风险类别。比较了两种PCE中符合指南推荐的他汀类药物和/或抗高血压药物一级预防的患者的百分比。26.7%的患者发生了风险重新分类(n=5571)，其中98.1%(n=5466)的患者被分配到更新的PCE中的较低风险类别。非糖尿病患者(14.0%)不再达到通过更新的PCE推荐他汀类药物作为一级预防的阈值。同样，13.8%的I期高血压患者不再达到使用更新的PCE推荐降压药的门槛。总而言之，风险重新分类发生在26.7%的患者中，主要是由于更新后的PCE分配的风险类别较低。使用最新的PCE，高达14.0%的患者不再达到推荐他汀类药物和/或降压药物的阈值。这些发现表明，使用最新的PCE可以转化为更少的患者接受ASCVD一级预防的药物治疗。
Shortly after the introduction of the 2013 original Pooled Cohort Equation (PCE), an overestimation of risk was suggested. As such, the updated 2018 PCE was developed to more accurately assess atherosclerotic cardiovascular disease (ASCVD) risk in the population. Hence, this study aims to compare drug prescribing recommendations in a large, real-world patient population, depending on which PCE is used to estimate 10-year ASCVD risk. This retrospective cohort study identified 20,843 patients aged between 40 and 75 years with no previous ASCVD. The 10-year ASCVD risk score was assessed by using both PCE. Patients were assigned to the four risk categories according to the 2018 ACC/AHA guideline. The percentage of patients qualifying for guideline-recommended primary prevention with statins and/or anti-hypertensives were compared between both PCE. Risk reclassification occurred in 26.7% of patients overall (n = 5571), of which 98.1% (n = 5466) were assigned to lower risk categories with the updated PCE. Non-diabetic (14.0%) patients no longer met the threshold for recommending statins as primary prevention with the updated PCE. Likewise, 13.8% of patients with stage I hypertension no longer met the threshold for recommending antihypertensive drugs with the updated PCE. In conclusion, risk reclassification occurred among 26.7% of patients overall, mostly due to lower risk categories assigned by the updated PCE. Up to 14.0% of patients no longer met the threshold for recommending statin therapy and/or antihypertensive drugs by using the updated PCE. These findings suggest that using the updated PCE could translate into fewer patients receiving pharmacotherapy for ASCVD primary prevention.
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影响因子：
24
作者：
Lloyd-Jones, Donald M.;Braun, Lynne T.;Blumenthal, Roger S.
通讯作者：
Blumenthal, Roger S.
影响因子：
37.8
作者：
Bress, Adam P.;Colantonio, Lisandro D.;Moran, Andrew E.
通讯作者：
Moran, Andrew E.
影响因子：
39.2
作者：
DeFilippis AP;Young R;Carrubba CJ;McEvoy JW;Budoff MJ;Blumenthal RS;Kronmal RA;McClelland RL;Nasir K;Blaha MJ
通讯作者：
Blaha MJ
影响因子：
39.2
作者：
Yadlowsky, Steve;Hayward, Rodney A.;Basu, Sanjay
通讯作者：
Basu, Sanjay
影响因子：
37.8
作者：
Grundy, SM;Becker, D;Jehle, AJ
通讯作者：
Jehle, AJ