Treatment gaps and potential cardiovascular risk reduction from expanded statin use in the US and England.
Treatment gaps and potential cardiovascular risk reduction from expanded statin use in the US and England.
复制标题
DOI：
10.1371/journal.pone.0190688
复制
发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Danaei G
中科院分区：
文献类型：
--
作者：
Ueda P;Lung TW;Lu Y;Salomon JA;Rahimi K;Clarke P;Danaei G
英国和美国更新的心血管风险评估和脂质调节国家指南将他汀类药物治疗在一级预防中的适应症扩展至中度心血管疾病（CVD）风险的成年人，但在这两个国家，许多高CVD风险的成年人仍未接受治疗。我们着手确定英国和美国成年人在中度和高度心血管疾病（CVD）风险中的治疗差距，并估计将他汀类药物治疗扩展到目前未经治疗的人群中可以预防的CVD事件数量。我们使用了来自2009-2013年英国健康调查和2007-2012年美国国家健康和营养检查调查的10，375名英国成年人和7，687名美国成年人的全国代表性样本，年龄在40-75岁之间，没有现有的CVD。我们使用风险算法和各国国家指南推荐的他汀类药物治疗的风险阈值将调查参与者分类为中度风险（英国10年CVD风险≥10%至<20%，美国风险≥7.5%至<20%）或高风险（≥ 20%的风险），并模拟将他汀类药物治疗扩展到目前未治疗的患者所能预防的事件数量。在英国（46.0%）和美国（49.7%），近一半的高CVD风险成年人没有接受他汀类药物治疗。在英国，将他汀类药物的使用扩大到145万高风险成人将在未来10年内挽救101，000（95%CI = 81，000 - 120，000）例CVD事件，而将治疗扩大到364万未经治疗的中度风险成人将阻止128，000（103，000 - 154，000）例CVD事件。在美国，将他汀类药物的使用扩大到527万未经治疗的高风险成年人将在10年内挽救384，000（305，000 - 461，000）例CVD事件，而在2029万未经治疗的中等风险成年人中，将预防616，000（493，000 - 738，000）例CVD事件。在英国和美国，将他汀类药物治疗扩展到未经治疗的中度风险成人将防止与将他汀类药物使用扩展到目前未经治疗的高风险成人数量少得多的事件数量相当的事件。预防心血管疾病的一个巨大潜力仍然是提高高危成人中他汀类药物治疗的覆盖率。
The updated national guidelines for cardiovascular risk assessment and lipid modification in the UK and US expand the indications for statin therapy in primary prevention to adults with moderate risk of cardiovascular disease (CVD) but many adults at high CVD risk remain untreated in both countries. We set out to identify treatment gaps in English and American adults at moderate and high risk of cardiovascular disease (CVD), and to estimate the number of CVD events that would be prevented from expanding statin therapy to those who are currently untreated. We used nationally representative samples of 10,375 English adults and 7,687 US adults aged 40–75 years and free of existing CVD from the Health Survey for England 2009–2013, and the National Health and Nutrition Examination Survey 2007–2012 in the US. We used the risk algorithms and the risk thresholds for statin therapy recommended by each country’s national guideline to categorize the survey participants into moderate-risk (≥10% to <20% 10-year risk of CVD in England and ≥7.5% to <20% risk in the US) or high-risk (≥20%risk) and simulated the number of events that would be prevented from expansion of statin therapy to those currently untreated. Close to half of adults at high CVD risk in England (46.0%) and the US (49.7%) were not receiving statins. Expanding statin use to 1.45 million high-risk adults in England would save 101,000 (95% CI = 81,000–120,000) CVD events in the next 10 years compared with 128,000 (103,000–154,000) CVD events that would be prevented from expanding treatment to 3.64 million untreated moderate-risk adults. In the US, expanding statin use to 5.27 million untreated high-risk adults would save 384,000 (305,000–461,000) CVD events over 10 years compared with 616,000 (493,000–738,000) CVD events that would be prevented from treating 20.29 million untreated moderate-risk adults. In both England and the US, expanding statin therapy to untreated moderate-risk adults would prevent a comparable number of events as expanding statin use to a much smaller number of currently untreated high-risk adults. A large potential for CVD prevention remains from improving coverage of statin therapy among high-risk adults.
登录
查看更多内容
影响因子：
105.7
作者：
Chamnan, Parinya;Simmons, Rebecca K.;Griffin, Simon J.
通讯作者：
Griffin, Simon J.
影响因子：
105.7
作者：
Hippisley-Cox, Julia;Coupland, Carol;Brindle, Peter
通讯作者：
Brindle, Peter
影响因子：
105.7
作者：
Marshall, T;Rouse, A
通讯作者：
Rouse, A
影响因子：
5.9
作者：
Homer, Kate;Boomla, Kambiz;Robson, John
通讯作者：
Robson, John
影响因子：
37.8
作者：
Grundy, SM;Becker, D;Jehle, AJ
通讯作者：
Jehle, AJ