Ferket Bart S, Colkesen Ersen B, Visser Jacob J, Spronk Sandra, Kraaijenhagen Roderik A, Steyerberg Ewout W, Hunink M G Myriam
Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands.
Arch Intern Med. 2010 Jan 11;170(1):27-40. doi: 10.1001/archinternmed.2009.434.
To appraise guidelines on cardiovascular risk assessment to guide selection of screening interventions for a health check.
Guidelines in the English language published between January 1, 2003, and May 2, 2009, were retrieved using MEDLINE and CINAHL. This was supplemented by searching the National Guideline Clearinghouse, National Library for Health, Canadian Medical Association Infobase, and G-I-N International Guideline Library.
We included guidelines developed on behalf of professional organizations from Western countries, containing recommendations on cardiovascular risk assessment for the apparently healthy population. Titles and abstracts were assessed by 2 independent reviewers. Of 1984 titles identified, 27 guidelines met our criteria.
Rigor of guideline development was assessed by 2 independent reviewers. One reviewer extracted information on conflicts of interest and recommendations.
Sixteen of 27 guidelines reported conflicts of interest and 17 showed considerable rigor. These included recommendations on assessment of total cardiovascular risk (7 guidelines), dyslipidemia (2), hypertension (2), and dysglycemia (7). Recommendations on total cardiovascular risk and dyslipidemia included prediction models integrating multiple risk factors, whereas remaining recommendations were focused on single risk factors. No consensus was found on recommended target populations, treatment thresholds, and screening tests.
Differences among the guidelines imply important variation in allocation of preventive interventions. To make informed decisions, physicians should use only the recommendations from rigorously developed guidelines.
评估心血管风险评估指南，以指导健康检查中筛查干预措施的选择。
使用MEDLINE和CINAHL检索了2003年1月1日至2009年5月2日期间发表的英文指南。通过搜索国家指南交换中心、国家健康图书馆、加拿大医学协会信息库和全球指南网国际指南图书馆对其进行补充。
我们纳入了代表西方国家专业组织制定的指南，其中包含对明显健康人群心血管风险评估的建议。标题和摘要由2名独立评审员评估。在识别出的1984个标题中，27项指南符合我们的标准。
指南制定的严谨性由2名独立评审员评估。一名评审员提取了利益冲突和建议方面的信息。
27项指南中有16项报告了利益冲突，17项显示出相当的严谨性。这些包括关于总心血管风险评估的建议（7项指南）、血脂异常（2项）、高血压（2项）和血糖异常（7项）。关于总心血管风险和血脂异常的建议包括整合多个风险因素的预测模型，而其余建议则侧重于单一风险因素。在推荐的目标人群、治疗阈值和筛查测试方面未达成共识。
指南之间的差异意味着预防性干预措施分配的重要差异。为了做出明智的决策，医生应仅使用严格制定的指南中的建议。
