Cardiology Department of Clinical and Molecular Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy.
J Hypertens. 2012 Jun;30(6):1056-64. doi: 10.1097/HJH.0b013e3283525715.
Cardiovascular risk assessment in the clinical practice is mostly based on risk charts, such as Framingham risk score and Systemic Coronary Risk Estimation (SCORE). These enable clinicians to estimate the impact of cardiovascular risk factors and assess individual cardiovascular risk profile. Risk charts, however, do not take into account subclinical organ damage, which exerts independent influence on risk and may amplify the estimated risk profile. Inclusion of organ damage markers in the assessment may thus contribute to improve this process.
Our aim was to evaluate the influence of implementation of SCORE charts with widely available indexes of organ damage, with the purpose to ameliorate individual risk assessment.
We searched www.Pubmed.gov for evidence about the predictive value of left ventricular hypertrophy (LVH), estimated glomerular filtration rate (eGFR), microalbuminuria (MAU) and metabolic syndrome on different risk profiles estimated by SCORE. Interventional and observational trials including at least 200 patients and published after 2000 were selected.
The presence of organ damage as well as the number of abnormal parameters indicating organ damage is associated with increased cardiovascular risk, independently of SCORE. In the area of high risk, the impact of different markers of organ damage is heterogeneous. Combined risk models of SCORE and subclinical organ damage have major impact on risk stratification and may impact on recommendation in primary prevention in all SCORE categories.
Available evidence suggests a tangible clinical advantage of adding the evaluation of simple organ damage markers to risk charts in cardiovascular risk prediction.
临床实践中的心血管风险评估主要基于风险图表，如弗雷明汉风险评分和系统性冠状动脉风险评估（SCORE）。这些图表使临床医生能够估计心血管危险因素的影响，并评估个体心血管风险状况。然而，风险图表并未考虑亚临床器官损伤，后者对风险有独立影响，并可能放大估计的风险状况。因此，将器官损伤标志物纳入评估可能有助于改善这一过程。
我们的目的是评估使用广泛可用的器官损伤指标实施 SCORE 图表对改善个体风险评估的影响。
我们在 www.Pubmed.gov 上搜索了关于左心室肥厚（LVH）、估算肾小球滤过率（eGFR）、微量白蛋白尿（MAU）和代谢综合征对 SCORE 估计的不同风险状况的预测价值的证据。选择了至少包含 200 名患者且发表于 2000 年后的干预性和观察性试验。
器官损伤的存在以及表明器官损伤的异常参数数量与心血管风险增加相关，这与 SCORE 无关。在高风险区域，不同器官损伤标志物的影响是不均匀的。SCORE 和亚临床器官损伤的联合风险模型对风险分层有重大影响，并可能影响所有 SCORE 类别中的一级预防推荐。
现有证据表明，在心血管风险预测中，将简单的器官损伤标志物评估添加到风险图表中具有明显的临床优势。
