Accuracy of cardiovascular risk estimation for primary prevention in patients without diabetes
Accuracy of cardiovascular risk estimation for primary prevention in patients without diabetes
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DOI：
10.1097/00043798-200208000-00002
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发表时间：
2002-08-01
期刊：
影响因子：
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通讯作者：
Wierzbicki, AS
中科院分区：
文献类型：
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作者：
Reynolds, TM;Twomey, P;Wierzbicki, AS
背景 动脉粥样硬化的负担导致根据风险评估优先考虑对没有确定心血管疾病的高危个体进行治疗。我们研究了危险因素的生物学变异对风险估计准确性的影响，以及当前的初级预防筛查（风险评估）模型是否正确对患者进行分类。方法对 10 000 名“完美”个体和 100 种受收缩压、总胆固醇、高密度脂蛋白胆固醇的生物学和分析变异影响的模拟物组成的群体进行了数学建模。使用 Framingham 研究算法计算冠心病 (CHID) 风险，并评估筛查系统的数学特性。 结果 在国际推荐的 10 年冠心病风险治疗阈值水平 15%、20% 和 30% 下，95% 置信区间为 +/- 5.1、+/- 6.0 和 +/- 6.9%（单点）、+/- 3.6、+/- 4.2 和 +/-对于重复估计为 4.9%，对于三次估计分别为 +/- 2.8、+/- 3.3 和 +/- 3.9%（即对于单次 15% 风险，95% 置信区间为 9.9-20.1%）。因此，使用国家服务框架 (NSF) 中针对 CHID 的 30% 风险阈值进行单一估计，30% 应该接受治疗的患者将被拒绝，20% 的患者将接受不必要的治疗。多次测量可以提高精度，但不能绝对定义风险。血压测量应尽可能精确，在求平均值之前不要四舍五入。结论这项研究表明，心血管危险因素的生物变异对治疗决策的计算风险具有深远的影响。当前建议进行多次测量的指南通常被忽略。需要进行三次测量才能识别风险，并且在解释结果时必须进行临床判断。 (C) 2002 年利平科特·威廉姆斯·威尔金斯。
Background The burden of atherosclerosis has led to treatment prioritization on high-risk individuals without established cardiovascular disease based on risk estimates. We investigated the effects of biological variation in risk factors on risk estimate accuracy and whether current primary prevention screening (risk assessment) models correctly categorize patients.Methods A population of 10 000 'perfect' individuals with 100 simulants affected by biological and analytical variation for systolic blood pressure, total cholesterol, high-density lipoprotein-cholesterol was mathematically modelled. Coronary heart disease (CHID) risks were calculated using the Framingham study algorithm and the mathematical properties of the screening system were evaluated.Results At internationally recommended 10-year CHD risk treatment threshold levels of 15, 20 and 30%, the 95% confidence intervals were +/- 5.1, +/- 6.0 and +/- 6.9% for single-point (singlicate), +/- 3.6, +/- 4.2 and +/- 4.9% for duplicate and +/- 2.8, +/- 3.3 and +/- 3.9% for triplicate estimates respectively (i.e. for singlicate 15% risk, 95% confidence interval is 9.9-20.1%). Consequently, using the 30% risk threshold from the National Service Framework (NSF) for CHID with singlicate estimation, 30% of patients who should receive treatment would be denied it and 20% would receive treatment unnecessarily. Multiple measurements improve precision but cannot absolutely define risk. Blood pressure should be measured to the greatest accuracy possible and not rounded prior to averaging.Conclusions This study suggests biological variation in cardiovascular risk factors has profound consequences on calculated risk for therapeutic decision-making. Current guidelines recommending multiple measurements are usually ignored. Triplicate measurement is required to allow risk to be identified and clinical judgement has to be exercised in interpretation of the results. (C) 2002 Lippincott Williams Wilkins.