Improving patient risk communication: Translating cardiovascular risk into standardized risk percentiles
Improving patient risk communication: Translating cardiovascular risk into standardized risk percentiles
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DOI：
10.1016/j.ahj.2017.12.005
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发表时间：
2018-04-01
影响因子：
4.8
通讯作者：
Peterson, Eric D.
中科院分区：
文献类型：
--
作者：
Navar, Ann Marie;Pencina, Michael J.;Peterson, Eric D.
目前的胆固醇指南建议使用动脉粥样硬化性心血管疾病（ASCVD）的10年风险来指导关于他汀类药物治疗的知情决策，但患者可能难以概念化绝对风险估计。同行比较可能为患者风险理解提供一种改进的工具。方法使用2009-2014年国家健康和营养检查调查（NHANES）的数据，我们估计了不同年龄，性别，和种族特定的亚组，根据他们的10-结果我们在NHANES中检查了9160名无心血管疾病并有完整临床资料的成年人。在特定的年龄、性别和种族组中，我们估计了10年风险的分布，计算了每个百分位数对应的10年风险，以生成标准化的心血管风险图。估计的10年ASCVD绝对风险因年龄、性别和种族亚组而显著不同。7.0%的10年风险将使55岁的黑人男性相对于同龄人处于第20百分位（即，风险低于同龄人的80%），而7.0%的10年风险将使55岁的白色女性处于第95百分位（即，只有5%的同龄人会有更高的风险）。按年龄、种族和性别列出的标准化心血管风险百分位数可在populationrelativerisk.dcri.org上在线获取。结论心血管风险因年龄、性别和种族而存在很大差异。这些数据允许将ASCVD的10年绝对风险转化为标准化的心血管风险百分位数，为患者提供易于理解的信息，即他们的个人心血管疾病风险与年龄，性别和种族匹配的同龄人相比如何。
Background Current cholesterol guidelines recommend using 10-year risk of atherosclerotic cardiovascular disease (ASCVD) to guide informed decisions regarding statin therapy, yet patients may have difficulty conceptualizing absolute risk estimates. Peer comparisons may provide an improved tool for patient risk comprehension.Methods Using data from the 2009-2014 National Health and Nutrition Examination Survey (NHANES), we estimated standardized risk percentiles for various age-, sex-, and race-specific subgroups based on their 10-year ASCVD risks using the Pooled Cohort Equations.Results We examined 9160 adults in NHANES who were free of cardiovascular disease and had complete clinical data. Among specific age, sex, and race groups, we estimated the distribution of 10-year risk, calculating the 10-year risk corresponding to each percentile in order to generate standardized cardiovascular risk percentiles. Estimated 10-year ASCVD absolute risk varied markedly by age, sex, and race subgroups. A 10-year risk of 7.0% would put a 55 year-old black male in the 20th percentile relative to his peers (ie, at lower risk than 80% of his peers), whereas a 10-year risk of 7.0% would put a 55 year-old white female in the 95th percentile (i.e., only 5% of her peers would have higher risk). Standardized cardiovascular risk percentiles by age, race, and sex are available online at populationrelativerisk.dcri.org.Conclusion Cardiovascular risk varies substantially by age, sex, and race. These data allow for 10-year absolute risks of ASCVD to be translated into a standardized cardiovascular risk percentile, providing patients with information that is easy to understanding regarding how their personal risk of cardiovascular disease compares with their age-, sex-, and race-matched peers.