2013 ACC/AHA versus 2004 NECP ATP III Guidelines in the Assignment of Statin Treatment in a Korean Population with Subclinical Coronary Atherosclerosis.
2013 ACC/AHA versus 2004 NECP ATP III Guidelines in the Assignment of Statin Treatment in a Korean Population with Subclinical Coronary Atherosclerosis.
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DOI：
10.1371/journal.pone.0137478
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Lee WJ
中科院分区：
文献类型：
--
作者：
Jung CH;Lee MJ;Kang YM;Yang DH;Kang JW;Kim EH;Park DW;Park JY;Kim HK;Lee WJ
2013年ACC/AHA指南对亚洲人群血液胆固醇管理的有效性仍存在争议。在这项研究中，我们调查了2013年ACC/AHA指南确定的他汀类药物治疗资格是否与CCTA（冠状动脉计算机断层扫描血管造影术）检测到的亚临床冠状动脉粥样硬化的存在更好地一致，而不是之前推荐的2004年NCEP ATP III指南。我们收集了5，837例在常规健康检查期间使用MDCT进行CCTA的无症状受试者的数据。基于风险因素评估和血脂数据，我们根据2013年ACC/AHA和2004年NCEP ATP III指南确定了他汀类药物治疗的指南资格。我们根据冠状动脉显著狭窄（定义为>50%狭窄）、斑块和冠状动脉钙化程度来定义CCTA中检测到的亚临床冠状动脉粥样硬化的存在和严重程度。与2004年ATP III指南相比，使用2013年ACC/AHA指南，将患有高血压（61.8% vs. 33.8%）、斑块（52.3% vs. 24.7%）和较高CACS（CACS >100，63.6% vs. 26.5%）的患者分配至他汀类药物治疗组（所有变量P < .001）。新指南的合并队列方程在检测显著狭窄、斑块和较高CACS方面的曲线下面积显著高于Fragrance风险计算器。与之前的ATP III指南相比，2013年ACC/AHA指南在识别亚洲人群中CCTA检测到的亚临床冠状动脉粥样硬化受试者方面更敏感。
The usefulness of the 2013 ACC/AHA guidelines for the management of blood cholesterol in the Asian population remains controversial. In this study, we investigated whether eligibility for statin therapy determined by the 2013 ACC/AHA guidelines is better aligned with the presence of subclinical coronary atherosclerosis detected by CCTA (coronary computed tomography angiography) compared to the previously recommended 2004 NCEP ATP III guidelines. We collected the data from 5,837 asymptomatic subjects who underwent CCTA using MDCT during routine health examinations. Based on risk factor assessment and lipid data, we determined guideline-based eligibility for statin therapy according to the 2013 ACC/AHA and 2004 NCEP ATP III guidelines. We defined the presence and severity of subclinical coronary atherosclerosis detected in CCTA according to the presence of significant coronary artery stenosis (defined as >50% stenosis), plaques, and the degree of coronary calcification. As compared to the 2004 ATP III guidelines, a significantly higher proportion of subjects with significant coronary stenosis (61.8% vs. 33.8%), plaques (52.3% vs. 24.7%), and higher CACS (CACS >100, 63.6% vs. 26.5%) was assigned to statin therapy using the 2013 ACC/AHA guidelines (P < .001 for all variables). The area under the curves of the pooled cohort equation of the new guidelines in detecting significant stenosis, plaques, and higher CACS were significantly higher than those of the Framingham risk calculator. Compared to the previous ATP III guidelines, the 2013 ACC/AHA guidelines were more sensitive in identifying subjects with subclinical coronary atherosclerosis detected by CCTA in an Asian population.