Sheridan Stacey L, Viera Anthony J, Krantz Mori J, Ice Christa L, Steinman Lesley E, Peters Karen E, Kopin Laurie A, Lungelow Danielle
University of North Carolina, Chapel Hill, 27599, USA.
Arch Intern Med. 2010 Feb 8;170(3):230-9. doi: 10.1001/archinternmed.2009.516.
Global coronary heart disease (CHD) risk estimation (ie, a quantitative estimate of a patient's chances of CHD calculated by combining risk factors in an empirical equation) is recommended as a starting point for primary prevention efforts in all US adults. Whether it improves outcomes is currently unknown.
To assess the effect of providing global CHD risk information to adults, we performed a systematic evidence review. We searched MEDLINE for the years 1980 to 2008, Psych Info, CINAHL, and the Cochrane Database and included English-language articles that met prespecified inclusion criteria. Two reviewers independently reviewed titles, abstracts, and articles for inclusion and assessed study quality.
We identified 20 articles, reporting on 18 unique fair or good quality studies (including 14 randomized controlled studies). These showed that global CHD risk information alone or with accompanying education increased the accuracy of perceived risk and probably increased intent to start therapy. Studies with repeated risk information or risk information and repeated doses of counseling showed small significant reductions in predicted CHD risk (absolute differences, -0.2% to -2% over 10 years in studies using risk estimates derived from Framingham equations). Studies providing global risk information at only 1 point in time seemed ineffective.
Global CHD risk information seems to improve the accuracy of risk perception and may increase intent to initiate CHD prevention among individuals at moderate to high risk. The effect of global risk presentation on more distal outcomes is less clear and seems to be related to the intensity of accompanying interventions.
全球冠心病（CHD）风险评估（即通过将风险因素纳入经验公式来定量估计患者患冠心病的几率）被推荐作为美国所有成年人一级预防工作的起点。目前尚不清楚它是否能改善预后。
为评估向成年人提供全球冠心病风险信息的效果，我们进行了一项系统的证据综述。我们检索了1980年至2008年的MEDLINE、Psych Info、CINAHL和Cochrane数据库，并纳入了符合预先设定纳入标准的英文文章。两名评审员独立评审标题、摘要和文章以确定是否纳入，并评估研究质量。
我们识别出20篇文章，报道了18项质量为中等或良好的独特研究（包括14项随机对照研究）。这些研究表明，单独的全球冠心病风险信息或与相关教育一起使用，可提高感知风险的准确性，并可能增加开始治疗的意愿。提供重复风险信息或风险信息及重复咨询剂量的研究显示，预测的冠心病风险有小幅显著降低（在使用弗雷明汉方程得出的风险估计值的研究中，10年间绝对差异为-0.2%至-2%）。仅在一个时间点提供全球风险信息的研究似乎无效。
全球冠心病风险信息似乎能提高风险感知的准确性，并可能增加中高风险个体启动冠心病预防的意愿。全球风险呈现方式对更远期预后的影响尚不清楚，似乎与伴随干预的强度有关。
