Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, MC 3248, Madison, WI 53792, USA.
Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
J Clin Lipidol. 2011 May-Jun;5(3):166-172. doi: 10.1016/j.jacl.2011.02.007. Epub 2011 Mar 2.
The Framingham Global Cardiovascular Disease (FRS-CVD) risk assessment is a proposed alternative for the assessment of hard coronary heart disease (FRS-CHD) event risk. Beyond heart attack and death, FRS-CVD risk adds the end points of cerebrovascular disease, angina, heart failure, and peripheral vascular disease.
We sought to estimate the population impact of using FRS-CVD instead of FRS-CHD risk prediction on U.S. adults.
We analyzed FRS-CHD and FRS-CVD risk in men age 45-74 and women age 55-74 without cardiovascular disease or diabetes, using the National Health and Nutrition Examination Survey 2005-2006. We stratified the population into 10-year risk categories: low: <6%, moderate ≥ 6 to <10%, moderate high ≥ 10 to <20%, and high ≥ 20% by both risk models, and assessed change in risk category distribution and achievement of lipid goals.
We analyzed 1020 subjects who statistically represent approximately 50 million U.S. adults. When the FRS-CVD was used, we found that 63% of men and 74% of women increase at least one risk category compared with when the FRS-CHD is used. Overall, the low-risk population decreases from 52% to 16% and the high-risk group increases from 4% to 20%. Of the subjects changing risk categories, 30% will now fail to meet their new corresponding lipid goals.
FRS-CVD end points are more comprehensive, yet the population implications of such a change may be profound. The use of a FRS-CVD risk model significantly increases the intermediate and high-risk groups, thus increasing the number of individuals eligible for novel risk assessment tools such as high-sensitivity C-reactive protein, coronary calcium scoring, and more frequent use of pharmacotherapy.
弗雷明汉全球心血管疾病（FRS-CVD）风险评估是一种替代硬冠状动脉心脏病（FRS-CHD）事件风险评估的方法。除了心脏病发作和死亡之外，FRS-CVD 风险还增加了脑血管疾病、心绞痛、心力衰竭和外周血管疾病的终点。
我们旨在估计在美国成年人中使用 FRS-CVD 替代 FRS-CHD 风险预测的人群影响。
我们使用 2005-2006 年全国健康和营养调查的数据，分析了无心血管疾病或糖尿病的 45-74 岁男性和 55-74 岁女性的 FRS-CHD 和 FRS-CVD 风险。我们将人群分为 10 年风险类别：低：<6%，中≥6%且<10%，中高≥10%且<20%，高≥20%，这两个风险模型都有，评估风险类别分布的变化和实现脂质目标的情况。
我们分析了 1020 名在统计学上代表大约 5000 万美国成年人的受试者。当使用 FRS-CVD 时，我们发现与使用 FRS-CHD 相比，63%的男性和 74%的女性至少增加了一个风险类别。总体而言，低危人群从 52%降至 16%，高危人群从 4%增至 20%。在改变风险类别的受试者中，30%的人现在将无法达到新的相应脂质目标。
FRS-CVD 终点更加全面，但这种变化的人群影响可能是深远的。使用 FRS-CVD 风险模型显著增加了中高危人群，从而增加了适合新型风险评估工具的个体数量，如高敏 C 反应蛋白、冠状动脉钙评分和更频繁地使用药物治疗。
