Department of Medicine, New York University School of Medicine, Leon H. Charney Division of Cardiovascular Medicine, New York, New York; Department of Medicine, University of Pennsylvania, Division of Cardiovascular Medicine, Philadelphia, Pennsylvania.
Department of Medicine, University of Minnesota, Division of Cardiovascular Medicine, Minneapolis, Minnesota.
J Am Coll Cardiol. 2010 Mar 23;55(12):1169-1177. doi: 10.1016/j.jacc.2009.09.066.
Cardiovascular disease is the number 1 cause of death in the western world and 1 of the leading causes of death worldwide. The lifetime risk of atherosclerotic cardiovascular disease (CVD) for persons at age 50 years, on average, is estimated to be 52% for men and 39% for women, with a wide variation depending on risk factor burden. Assessing patients' cardiovascular risk may be used for the targeting of preventive treatments of individual patients who are asymptomatic but at sufficiently high risk for the development of CVD. Risk stratifying patients for CVD remains challenging, particularly for those with low or intermediate short-term risk. Several algorithms have been described to facilitate the assessment of risk in individual patients. We describe 6 risk algorithms (Framingham Risk Score for coronary heart disease events and for cardiovascular events, Adult Treatment Panel III, SCORE [Systematic Coronary Risk Evaluation] project, Reynolds Risk Score, ASSIGN [Assessing Cardiovascular Risk to Scottish Intercollegiate Guidelines Network/SIGN to Assign Preventative Treatment], and QRISK [QRESEARCH Cardiovascular Risk Algorithm]) for outcomes, population derived/validated, receiver-operating characteristic, variables included, and limitations. Areas of uncertainty include 10-year versus lifetime risk, prediction of CVD or coronary heart disease end points, nonlaboratory-based risk scores, age at which to start, race and sex differences, and whether a risk score should guide therapy. We believe that the best high-risk approach to CVD evaluation and prevention lies in routine testing for cardiovascular risk factors and risk score assessment. We recommend that health care providers discuss the global cardiovascular risk and lifetime cardiovascular risk score assessment with each patient to better explain each patient's future risk. Appropriate intervention, guided by risk assessment, has the potential to bring about a significant reduction in population levels of risk.
心血管疾病是西方世界头号死因，也是全球主要死因之一。平均而言，50 岁人群发生动脉粥样硬化性心血管疾病（CVD）的终身风险估计为男性 52%，女性 39%，但风险因素负担存在广泛差异。评估患者的心血管风险可用于针对无症状但 CVD 发病风险较高的个体患者进行预防性治疗。对 CVD 风险进行分层仍然具有挑战性，尤其是对那些短期风险较低或中等的患者。已经描述了几种算法来帮助评估个体患者的风险。我们描述了 6 种风险算法（Framingham 冠心病风险评分和心血管事件风险评分、成人治疗专家组 III、SCORE[系统冠状动脉风险评估]项目、Reynolds 风险评分、ASSIGN[评估苏格兰校际指南网络/SIGN 以分配预防性治疗的心血管风险]和 QRISK[QRESEARCH 心血管风险算法]），用于评估结果、人群衍生/验证、接受者操作特征、包含的变量和局限性。不确定性领域包括 10 年与终身风险、CVD 或冠心病终点预测、非实验室风险评分、开始年龄、种族和性别差异以及风险评分是否应指导治疗。我们认为，评估和预防 CVD 的最佳高危方法在于常规检测心血管危险因素和风险评分评估。我们建议医疗保健提供者与每位患者讨论全球心血管风险和终身心血管风险评分评估，以更好地解释每位患者的未来风险。根据风险评估进行适当的干预有潜力显著降低人群的风险水平。
