Chen Lei, Rogers Sophie L, Colagiuri Stephen, Cadilhac Dominique A, Mathew Timothy H, Boyden Andrew N, Peeters Anna, Magliano Dianna J, Shaw Jonathan E, Zimmet Paul Z, Tonkin Andrew M
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Med J Aust. 2008 Sep 15;189(6):319-22. doi: 10.5694/j.1326-5377.2008.tb02049.x.
To determine how well the current Pharmaceutical Benefits Scheme (PBS) eligibility criteria for subsidy of lipid-lowering drugs compare with current national guidelines for determining the population at high risk of developing cardiovascular disease (CVD).
Analyses of the population-based, cross-sectional Australian Diabetes, Obesity and Lifestyle (AusDiab) study, conducted in 1999-2000. The 1991 Framingham risk prediction equation was used to compute 5-year risk of developing first-time CVD in 8286 participants aged 30-74 years with neither CVD nor diabetes. Based on the National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand guidelines, people with either 5-year CVD risk > or = 15% or with 5-year CVD risk of 10%-< 15% and the metabolic syndrome were defined as having estimated high absolute CVD risk.
5-year CVD risk; estimated population with high CVD risk.
Among participants without prevalent CVD or diabetes, 7.9% of men and 1.5% of women had a 5-year CVD risk > or = 15%. Of the estimated residential Australian population in 2000 aged 30-74 years without CVD or diabetes, 717 000 people were considered to be at high absolute CVD risk. Among the high-risk AusDiab participants without CVD or diabetes, only 16.9% of men and 15.4% of women were being treated with lipid-lowering drugs. Of the 9.6% of participants free of CVD and diabetes who were untreated but eligible for subsidy under PBS criteria, only 27.4% had an estimated high absolute CVD risk.
Strategies for CVD prevention using lipid-lowering medications can be improved by adoption of the absolute-risk approach.
确定当前药品福利计划（PBS）中降脂药物补贴的资格标准与当前确定心血管疾病（CVD）高风险人群的国家指南相比的契合程度。
对1999 - 2000年开展的基于人群的横断面澳大利亚糖尿病、肥胖与生活方式（AusDiab）研究进行分析。采用1991年弗明汉风险预测方程计算8286名年龄在30 - 74岁、既无CVD也无糖尿病的参与者首次发生CVD的5年风险。根据澳大利亚国家心脏基金会以及澳大利亚和新西兰心脏学会的指南，将5年CVD风险≥15%或5年CVD风险为10% - ＜15%且患有代谢综合征的人定义为估计具有高绝对CVD风险。
5年CVD风险；估计的CVD高风险人群。
在无CVD或糖尿病病史的参与者中，7.9%的男性和1.5%的女性5年CVD风险≥15%。在2000年估计的30 - 74岁无CVD或糖尿病的澳大利亚居民中，71.7万人被认为具有高绝对CVD风险。在无CVD或糖尿病的AusDiab高风险参与者中，只有16.9%的男性和15.4%的女性正在接受降脂药物治疗。在无CVD和糖尿病且未接受治疗但符合PBS标准可获补贴的9.6%参与者中，只有27.4%的人估计具有高绝对CVD风险。
采用绝对风险方法可改善使用降脂药物预防CVD的策略。
