Clinical Implications of Revised Pooled Cohort Equations for Estimating Atherosclerotic Cardiovascular Disease Risk
Clinical Implications of Revised Pooled Cohort Equations for Estimating Atherosclerotic Cardiovascular Disease Risk
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DOI：
10.7326/m17-3011
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发表时间：
2018-07-03
影响因子：
39.2
通讯作者：
Basu, Sanjay
中科院分区：
文献类型：
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作者：
Yadlowsky, Steve;Hayward, Rodney A.;Basu, Sanjay
背景资料：2013年合并队列方程（PCE）是心血管疾病（CVD）预防指南的核心，但可能会错误估计CVD风险。目的：通过使用更新的数据和统计方法修订2013年PCE，以提高CVD风险预测的临床准确性。设计：风险方程的推导和验证。设置：基于人群。参与者：来自6个美国队列的26 689名年龄在40至79岁之间、既往无CVD的成年人。测量指标：非致命性心肌梗死、冠心病死亡或致命性或非致命性卒中。结果：2013年PCE高估了10年动脉粥样硬化CVD风险，在风险组中平均高估了20%。对风险的错误估计在黑人成年人中尤为突出，其中390万人（占符合条件的黑人的33%）有极端风险估计（占白色成年人的250%，风险因素值在其他方面相同）。更新这些方程提高了所有种族和性别亚组的准确性。约1180万美元。S.之前被2013年PCE标记为高风险（10年风险>= 7.5%）的成年人将被更新后的方程重新标记为低风险。局限性：用现代队列的数据更新2013年PCE减少了被认为处于高风险的人数。临床医生和患者应该考虑减少推荐使用阿司匹林、血压或他汀类药物治疗的人数的潜在益处和危害。我们的研究结果还表明，风险方程一般会随着时间的推移变得过时，需要例行updation.Conclusion：修订PCE可以提高CVD风险估计的准确性。
Background: The 2013 pooled cohort equations (PCEs) are central in prevention guidelines for cardiovascular disease (CVD) but can misestimate CVD risk.Objective: To improve the clinical accuracy of CVD risk prediction by revising the 2013 PCEs using newer data and statistical methods.Design: Derivation and validation of risk equations.Setting: Population-based.Participants: 26 689 adults aged 40 to 79 years without prior CVD from 6 U.S. cohorts.Measurements: Nonfatal myocardial infarction, death from coronary heart disease, or fatal or nonfatal stroke.Results: The 2013 PCEs overestimated 10-year risk for atherosclerotic CVD by an average of 20% across risk groups. Misestimation of risk was particularly prominent among black adults, of whom 3.9 million (33% of eligible black persons) had extreme risk estimates (250% those of white adults with otherwise-identical risk factor values). Updating these equations improved accuracy among all race and sex subgroups. Approximately 11.8 million U. S. adults previously labeled high-risk (10year risk >= 7.5%) by the 2013 PCEs would be relabeled lower-risk by the updated equations.Limitations: Updating the 2013 PCEs with data from modern cohorts reduced the number of persons considered to be at high risk. Clinicians and patients should consider the potential benefits and harms of reducing the number of persons recommended aspirin, blood pressure, or statin therapy. Our findings also indicate that risk equations will generally become outdated over time and require routine updating.Conclusion: Revised PCEs can improve the accuracy of CVD risk estimates.