2013 ACC/AHA Cholesterol Guideline Versus 2004 NCEP ATP III Guideline in the Prediction of Coronary Artery Calcification Progression in a Korean Population.
2013 ACC/AHA Cholesterol Guideline Versus 2004 NCEP ATP III Guideline in the Prediction of Coronary Artery Calcification Progression in a Korean Population.
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DOI：
10.1161/jaha.116.003410
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发表时间：
2016-08-19
影响因子：
5.4
通讯作者：
Lee WJ
中科院分区：
文献类型：
--
作者：
Cho YK;Jung CH;Kang YM;Hwang JY;Kim EH;Yang DH;Kang JW;Park JY;Kim HK;Lee WJ
自2013年美国心脏病学会/美国心脏协会（ACC/AHA）指南发布以来，围绕新胆固醇指南和合并队列方程的适用性存在重大争议。在本研究中，我们调查了2013年ACC/AHA血液胆固醇管理指南确定的他汀类药物治疗资格是否与冠状动脉计算机断层扫描血管造影术（CCTA）检测到的冠状动脉钙化（CAC）进展比之前推荐的2004年国家胆固醇教育计划（NCEP）成人治疗小组（ATP）III指南更一致。我们招募了1246名无症状的参与者，他们在常规健康检查期间重复进行CAC评分测量。CAC评分进展定义为基线时无CAC的人群中发生CAC，或基线检查时可检测到CAC的参与者的CAC评分的最终平方根与基线之间增加≥2.5个单位。将ACC/AHA指南应用于研究人群使他汀类药物合格受试者的比例从20.5%（根据ATP III）增加至54.7%。根据ACC/AHA指南定义，符合他汀类药物治疗条件的受试者的CAC评分进展的比值比高于根据ATP III指南认为符合他汀类药物治疗条件的受试者（2.73 [95% CI，2.07-3.61] vs 2.00 [95% CI，1.49-2.68]）。与ATP III指南相比，新的ACC/AHA指南在亚洲人群中通过CAC评分进展检测到心血管风险的受试者中得到了更好的区分。
Since the release of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines, significant controversy has surrounded the applicability of the new cholesterol guidelines and the Pooled Cohort Equations. In this present study, we investigated whether eligibility for statin therapy determined by the 2013 ACC/AHA guidelines on the management of blood cholesterol is better aligned with the progression of coronary artery calcification (CAC) detected by coronary computed tomography angiography (CCTA) than the previously recommended 2004 National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III guidelines. We enrolled 1246 asymptomatic participants who underwent repeated CAC score measurement during routine health examinations. The CAC score progression was defined as either incident CAC in a population free of CAC at baseline or increase ≥2.5 units between the baseline and final square root of CAC scores participants who had detectable CAC at baseline examination. Application of the ACC/AHA guidelines to the study population increased the proportion of statin‐eligible subjects from 20.5% (according to ATP III) to 54.7%. Statin‐eligible subjects, as defined by ACC/AHA guidelines, showed a higher odds ratio for CAC score progression than those considered statin eligible according to ATP III guidelines (2.73 [95% CI, 2.07–3.61] vs 2.00 [95% CI, 1.49–2.68]). Compared with the ATP III guidelines, the new ACC/AHA guidelines result in better discrimination of subjects with cardiovascular risk detected by CAC score progression in an Asian population.