Further insight into the cardiovascular risk calculator: the roles of statins, revascularizations, and underascertainment in the Women's Health Study.
Further insight into the cardiovascular risk calculator: the roles of statins, revascularizations, and underascertainment in the Women's Health Study.
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进一步了解心血管风险计算器：他汀类药物，血运重建和不足症的作用在妇女健康研究中。
DOI：
10.1001/jamainternmed.2014.5336
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发表时间：
2014-12
影响因子：
39
通讯作者：
Ridker, Paul M.
中科院分区：
文献类型：
--
作者：
Cook, Nancy R.;Ridker, Paul M.
虽然最近ACC/AHA心血管风险评估指南中的合并队列方程在多个外部队列中高估了心血管风险，但差异的原因尚不清楚。为了确定是否随着时间的推移，他汀类药物的使用增加，冠状动脉血管重建术的事件，或血管事件的不足，解释了在更现代的人群中高估风险的原因。来自妇女健康研究(WHS)的27,542名年龄在45岁至79岁之间的女性完全确定了血脂和其他风险因素，该研究是一项全国性的队列研究，在1992-95年间没有心血管疾病、癌症或其他重大疾病的美国女性。女性被跟踪调查的时间中位数为10年。动脉粥样硬化性心血管疾病(ASCVD)，定义为任何心肌梗死、任何中风或因心血管原因而死亡。632名妇女在随访期间经历了ASCVD事件。来自集合队列方程的平均预测风险在10年内为3.6%，而实际观察到的风险为2.2%。在0-5%和5-7.5%风险组中，预测率比观察值高90%，在7.5%和10%以上风险组中，预测率比观察率高40%。他汀类药物的使用率和血管重建率随着随访时间和风险组的增加而增加，在敏感性分析中，我们估计了没有服用他汀类药物或接受血管重建术的女性的假设率。在调整了他汀类药物和血管重建的干预效果以及按适应症进行假设混淆后，低两个风险组的预测率仍比观察值高80%，而上两个风险组的预测率则高出30%。确定不足的可能性不大，因为WHS的随访率为97%，总体来说，我们需要增加60%的事件才能与使用集合队列方程预测的数字匹配。无论是他汀类药物的使用、血运重建过程，还是事件的未确知，都不能解释WHS中观察到的ASCVD发生率与ACC/AHA合并队列方程预测的ASCVD发生率之间的差异。其他解释包括在更现代的人群中改变风险模式。
While the Pooled Cohort Equations from the recent ACC/AHA Guideline on the Assessment of Cardiovascular Risk have over-estimated cardiovascular risk in multiple external cohorts, the reasons for the discrepancy are unclear. To determine whether increased use of statins over time, incident coronary revascularization procedures, or under-ascertainment of vascular events explain over-estimation of risk in a more contemporary population. 27,542 women aged 45-79 with complete ascertainment of plasma lipids and other risk factors from the Women's Health Study (WHS), a nationwide cohort of US women free of cardiovascular disease, cancer or other major illness at baseline in 1992-95. Women were followed for a median of 10 years. Atherosclerotic cardiovascular disease (ASCVD), defined as any myocardial infarction, any stroke, or death due to cardiovascular cause. 632 women experienced an ASCVD event over follow-up. The average predicted risk from the Pooled Cohort Equations was 3.6% over 10 years, compared to an actual observed risk of 2.2%. Predicted rates were 90% higher than the observed rates in the 0-<5% and 5-<7.5% risk groups and 40% higher in the 7.5-<10% and 10%+ risk groups. Rates of statin use and revascularizations increased over follow-up time and by risk group, and in sensitivity analyses, we estimated the hypothetical rates if no women were on statins or underwent revascularization procedures. After adjustment for intervention effects of statins and revascularization as well as hypothetical confounding by indication, predicted rates remained 80% higher than observed rates in the lower two risk groups and 30% higher in the upper two risk groups. Under-ascertainment is unlikely since follow-up rates in the WHS were 97%, and overall we would need 60% more events to match the numbers predicted using the Pooled Cohort Equations. Neither statin use, revascularization procedures, nor under-ascertainment of events explain the discrepancy between observed rates of ASCVD in the WHS and those predicted by the ACC/AHA Pooled Cohort Equations. Other explanations include changing patterns of risk within more contemporary populations.
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影响因子：
3.7
作者：
Cholesterol Treatment Trialists' (CTT) Collaboration;Emberson JR;Kearney PM;Blackwell L;Newman C;Reith C;Bhala N;Holland L;Peto R;Keech A;Collins R;Simes J;Baigent C
通讯作者：
Baigent C
影响因子：
37.8
作者：
Ridker PM;Paynter NP;Rifai N;Gaziano JM;Cook NR
通讯作者：
Cook NR
影响因子：
37.8
作者：
Myerson, Merle;Coady, Sean;Goff, David C., Jr.
通讯作者：
Goff, David C., Jr.
影响因子：
120.7
作者：
Kavousi, Maryam;Leening, Maarten J. G.;Franco, Oscar H.
通讯作者：
Franco, Oscar H.
DOI：
10.1089/152460900318911
发表时间：
2000-01-01
期刊：
JOURNAL OF WOMENS HEALTH & GENDER-BASED MEDICINE
影响因子：
--
作者：
Rexrode, KM;Lee, IM;Buring, JE
通讯作者：
Buring, JE