Lloyd-Jones Donald M
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ilinois 60611, USA.
Curr Opin Lipidol. 2006 Dec;17(6):619-25. doi: 10.1097/MOL.0b013e3280108740.
The aim of this article is to describe recent advances in our understanding of lifetime risks for cardiovascular disease and their implications for lipid guidelines.
Recent studies have indicated that, among younger and middle-aged adults, there is a large subset with low 10-year risk but high lifetime risk for cardiovascular disease. Individuals with high lifetime risks can be identified on the basis of single adverse risk factors or on the basis of overall risk factor burden. For example, using the ATP-III online risk estimator, a 45-year-old obese, nonsmoking, nondiabetic man with total cholesterol of 200 mg/dl, HDL-cholesterol of 40 mg/dl, and untreated systolic blood pressure of 135 mmHg has an estimated 10-year risk for hard coronary heart disease of 3%. In contrast, recent data indicate that his predicted remaining lifetime risk for cardiovascular disease is 50% and his predicted median survival is over 10 years shorter than a man at the same age with optimal risk factors.
Lifetime risk estimation for cardiovascular disease may be an important adjunct to short-term (10-year) risk estimation that may help identify more treatment-eligible individuals at risk for cardiovascular disease, improve risk communication, motivate changes in lifestyle and behaviors, and promote adherence to therapy.
本文旨在描述我们对心血管疾病终生风险的理解方面的最新进展及其对血脂指南的影响。
近期研究表明，在年轻和中年成年人中，有很大一部分人10年风险较低，但心血管疾病终生风险较高。可以根据单一不良风险因素或根据总体风险因素负担来识别终生风险高的个体。例如，使用ATP-III在线风险评估工具，一名45岁的肥胖、不吸烟、非糖尿病男性，总胆固醇为200mg/dl，高密度脂蛋白胆固醇为40mg/dl，未治疗的收缩压为135mmHg，其患严重冠心病的估计10年风险为3%。相比之下，近期数据表明，他患心血管疾病的预测终生剩余风险为50%，且其预测中位生存期比具有最佳风险因素的同年龄男性短10年以上。
心血管疾病终生风险评估可能是短期（10年）风险评估的重要辅助手段，有助于识别更多有心血管疾病风险且适合治疗的个体，改善风险沟通，促使生活方式和行为发生改变，并促进对治疗的依从性。
