使用 SCORE、Framingham 和 ESH/ESC 风险图表的脉搏波速度、尿白蛋白肌酐比和左心室质量指数的阈值。

Thresholds for pulse wave velocity, urine albumin creatinine ratio and left ventricular mass index using SCORE, Framingham and ESH/ESC risk charts.

机构信息

CV Research Unit, Department of Internal Medicine, Glostrup University Hospital, Denmark.

出版信息

J Hypertens. 2012 Oct;30(10):1928-36. doi: 10.1097/HJH.0b013e328356c579.

DOI:10.1097/HJH.0b013e328356c579

PMID:22871892

Abstract

AIMS

Markers of subclinical target organ damage (TOD) increase cardiovascular (CV) risk prediction beyond traditional risk factors. We wanted to establish thresholds for three markers of TOD based on absolute CV risk in different risk chart categories.

METHODS AND RESULTS

In a cohort of 1968 healthy patients, we measured urine albumin creatine ratio (UACR), pulse wave velocity (PWV), left ventricular mass index (LVMI) and traditional risk factors. Patients were categorized according to Systemic Coronary Evaluation (SCORE), European Society of Hypertension/European Society of Cardiology (ESH/ESC) risk chart and Framingham risk score (FRS) and three corresponding endpoints were recorded: CV death (SCORE-endpoint), a composite of CV death and nonfatal myocardial infarction and stroke (ESH/ESC-endpoint), and a composite that also included hospital admissions for ischemic heart disease, heart failure, peripheral arterial disease and transient cerebral ischemic attack (FRS-endpoint). During a median follow of 12.8 years events totaled 81 SCORE-, 153 ESH/ESC-endpoints and 280 FRS-endpoints. Thresholds for UACR, PWV and LVMI are presented using 10-year risk threshold of more than 5% (SCORE-endpoint), more than 10%(ESH/ESC-endpoint) and more than 20%(FRS-endpoint), which indicated high risk and eligibility for primary prevention. As an example, the threshold was 0.83 mg/mmol, 13.7 m/s and 119 g/m for UACR, PWV and LVMI, respectively, for patients at moderate added risk according to ESH/ESC risk chart.

CONCLUSION

Thresholds for UACR, PVW and LVMI based on absolute risk have primarily impact on risk stratification in patients with intermediate risk. The thresholds for PWV and LVMI in patients with moderate risk according to the ESH/ESC risk chart were similar to currently applied thresholds whereas the threshold for UACR was considerable lower than the threshold for microalbuminuria.

摘要

目的

亚临床靶器官损害（TOD）标志物可增加心血管（CV）风险预测的准确性，超越传统风险因素。我们希望根据不同风险图表类别的绝对 CV 风险，为三种 TOD 标志物建立基于绝对值的风险预测切点。

方法和结果

在一项由 1968 名健康患者组成的队列中，我们测量了尿白蛋白肌酐比（UACR）、脉搏波速度（PWV）、左心室质量指数（LVMI）和传统危险因素。根据系统冠状动脉评估（SCORE）、欧洲高血压学会/欧洲心脏病学会（ESH/ESC）风险图表和 Framingham 风险评分（FRS）对患者进行分类，并记录了三个相应的终点：CV 死亡（SCORE 终点）、CV 死亡和非致命性心肌梗死及卒中的复合终点（ESH/ESC 终点）以及包括缺血性心脏病、心力衰竭、外周动脉疾病和短暂性脑缺血发作住院的复合终点（FRS 终点）。在中位数为 12.8 年的随访期间，共发生 81 例 SCORE 终点事件、153 例 ESH/ESC 终点事件和 280 例 FRS 终点事件。UACR、PWV 和 LVMI 的切点采用 10 年风险超过 5%（SCORE 终点）、10%（ESH/ESC 终点）和 20%（FRS 终点）的切点表示，提示高风险和适合初级预防。例如，ESH/ESC 风险图表中中等附加风险患者的 UACR、PWV 和 LVMI 切点分别为 0.83mg/mmol、13.7m/s 和 119g/m。