Application of New Cholesterol Guidelines to a Population-Based Sample
Application of New Cholesterol Guidelines to a Population-Based Sample
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DOI：
10.1056/nejmoa1315665
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发表时间：
2014-04-10
影响因子：
158.5
通讯作者：
Peterson, Eric D.
中科院分区：
文献类型：
--
作者：
Pencina, Michael J.;Navar-Boggan, Ann Marie;Peterson, Eric D.
美国心脏病学会和美国心脏协会（ACC-AHA） 2013年胆固醇治疗指南扩大了他汀类药物治疗预防心血管疾病的适应症。方法：利用2005年至2010年全国健康与营养调查的数据，我们估计了在新的ACC-AHA指南下推荐他汀类药物治疗的人数，并总结了风险因素概况，并与国家胆固醇教育计划第三成人治疗小组（ATP III）的指南进行了比较。并将结果外推到1.154亿40至75岁的美国成年人身上。结果与ATP-III指南相比，新指南将使接受或符合他汀类药物治疗的美国成年人数量从4320万（37.5%）增加到5600万（48.6%）。这些增加的人数（1280万人中的1040万人）中的大多数将发生在没有心血管疾病的成年人中。在没有接受他汀类药物治疗的60 - 75岁无心血管疾病的成年人中，男性中有资格接受这种治疗的比例将从30.4%增加到87.4%，女性中从21.2%增加到53.6%。这种影响很大程度上是由于越来越多的成年人将仅仅根据他们10年心血管事件的风险进行分类。新近有资格接受他汀类药物治疗的人群包括男性多于女性，以及血压较高但低密度脂蛋白胆固醇水平明显较低的人群。与ATP-III指南相比，新指南将推荐他汀类药物治疗更多未来可能发生心血管事件的成年人（敏感性更高），但也将包括许多未来不会发生心血管事件的成年人（特异性较低）。新的ACC-AHA胆固醇管理指南将使有资格接受他汀类药物治疗的成人人数增加1280万，其中增加的主要是无心血管疾病的老年人。（由杜克临床研究所等机构资助。）研究人员利用NHANES 2005年至2010年的数据来推断2013年新版胆固醇治疗指南在美国的效果。他们估计，新指南将使有资格接受他汀类药物治疗的成人人数增加1280万。直到最近，美国国家胆固醇教育计划的第三成人治疗小组（ATP III）的指南被推荐为帮助治疗高脂血症的指南。(1),(2) ATP-III指南确定患有心血管疾病或糖尿病且低密度脂蛋白（LDL）胆固醇水平为100 mg /分升（2.59 mmol /升）或更高的患者为他汀类药物治疗的候选者。此外，ATP-III指南建议在综合评估LDL胆固醇水平和10年冠心病风险的基础上，对患者使用他汀类药物进行一级预防。
BackgroundThe 2013 guidelines of the American College of Cardiology and the American Heart Association (ACC-AHA) for the treatment of cholesterol expand the indications for statin therapy for the prevention of cardiovascular disease.MethodsUsing data from the National Health and Nutrition Examination Surveys of 2005 to 2010, we estimated the number, and summarized the risk-factor profile, of persons for whom statin therapy would be recommended (i.e., eligible persons) under the new ACC-AHA guidelines, as compared with the guidelines of the Third Adult Treatment Panel (ATP III) of the National Cholesterol Education Program, and extrapolated the results to a population of 115.4 million U.S. adults between the ages of 40 and 75 years.ResultsAs compared with the ATP-III guidelines, the new guidelines would increase the number of U.S. adults receiving or eligible for statin therapy from 43.2 million (37.5%) to 56.0 million (48.6%). Most of this increase in numbers (10.4 million of 12.8 million) would occur among adults without cardiovascular disease. Among adults between the ages of 60 and 75 years without cardiovascular disease who are not receiving statin therapy, the percentage who would be eligible for such therapy would increase from 30.4% to 87.4% among men and from 21.2% to 53.6% among women. This effect would be driven largely by an increased number of adults who would be classified solely on the basis of their 10-year risk of a cardiovascular event. Those who would be newly eligible for statin therapy include more men than women and persons with a higher blood pressure but a markedly lower level of low-density lipoprotein cholesterol. As compared with the ATP-III guidelines, the new guidelines would recommend statin therapy for more adults who would be expected to have future cardiovascular events (higher sensitivity) but would also include many adults who would not have future events (lower specificity).ConclusionsThe new ACC-AHA guidelines for the management of cholesterol would increase the number of adults who would be eligible for statin therapy by 12.8 million, with the increase seen mostly among older adults without cardiovascular disease. (Funded by the Duke Clinical Research Institute and others.)The investigators used NHANES data for 2005 to 2010 to extrapolate the effects of the new 2013 cholesterol treatment guidelines across the United States. They estimate that the new guidelines would increase the number of adults eligible for statin therapy by 12.8 million. Until recently, the guidelines of the Third Adult Treatment Panel (ATP III) of the National Cholesterol Education Program were the recommended guidelines to aid in the treatment of hyperlipidemia in the United States.(1),(2) The ATP-III guidelines identified patients with established cardiovascular disease or diabetes and low-density lipoprotein (LDL) cholesterol levels of 100 mg per deciliter (2.59 mmol per liter) or higher as candidates for statin therapy. In addition, the ATP-III guidelines recommended the use of statin therapy for primary prevention in patients on the basis of a combined assessment of LDL cholesterol level and the 10-year risk of coronary ...