Department of Health Sciences, University of Leicester, Leicester LE1 6TP, UK.
J R Soc Med. 2012 Aug;105(8):348-56. doi: 10.1258/jrsm.2012.110193.
The high prevalence of cardiovascular disease (CVD) and the increased cost of treatment have prompted strategies for the primary prevention of CVD in the UK to move towards the use of validated CVD risk scores to identify individuals at the highest risk. There are no reviews evaluating the effectiveness of this strategy as a means of reducing CVD risk or mortality. This review summarizes current evidence for and against the use of validated CVD risk scores for the primary prevention of CVD.
We utilized an in depth search strategy to search MEDLINE, EMBASE and the Cochrane database of clinical trials, expert opinions were sought and reference lists of identified studies and relevant reviews were checked. Due to a lack of homogeneity in outcomes and risk scores used it was not possible to conduct a meta-analysis of the identified studies.
The majority of included trials were carried out in a primary care setting. 2 trials were carried out in North America, 2 in Scandinavia and 1 in the UK.
31,651 participants in total were recruited predominantly from a primary care setting. Participants were aged 18-65 years old and were free from CVD at baseline.
Outcome measures used in the included studies were change in validated CVD risk score and CVD/All-cause mortality.
We identified 16 papers which matched the inclusion criteria reporting 5 unique trials. Due to a lack of homogeneity in outcomes and risk scores used it was not possible to conduct a meta-analysis of the identified studies. Only one study reported a significant difference in risk score at follow up and one study reported a significant difference in total mortality, however significant differences in individual risk factors were reported by the majority of identified studies.
This review demonstrates the potential for multifactorial interventions aimed at individuals selected by CVD risk scores for lowering CVD risk and mortality. However, the majority of studies in this area do not provide an intensity of intervention which is sufficient in significantly reducing CVD mortality or validated CVD risk.
心血管疾病（CVD）的高发率和治疗成本的增加促使英国采取策略，将 CVD 一级预防转向使用经过验证的 CVD 风险评分来识别风险最高的个体。目前尚无评估该策略作为降低 CVD 风险或死亡率的有效性的综述。本综述总结了目前支持和反对使用经过验证的 CVD 风险评分进行 CVD 一级预防的证据。
我们利用深入的搜索策略搜索了 MEDLINE、EMBASE 和 Cochrane 临床试验数据库，征求了专家意见，并检查了已确定研究和相关综述的参考文献列表。由于结果和使用的风险评分缺乏同质性，因此无法对确定的研究进行荟萃分析。
大多数纳入的试验都是在初级保健环境中进行的。有 2 项试验在北美进行，2 项在斯堪的纳维亚进行，1 项在英国进行。
共有 31651 名参与者，主要来自初级保健环境。参与者年龄在 18-65 岁之间，基线时无 CVD。
纳入研究中使用的观察指标为经过验证的 CVD 风险评分的变化和 CVD/全因死亡率。
我们确定了 16 篇符合纳入标准的论文，报道了 5 项独特的试验。由于结果和使用的风险评分缺乏同质性，因此无法对确定的研究进行荟萃分析。只有一项研究报告了随访时风险评分的显著差异，一项研究报告了总死亡率的显著差异，但大多数确定的研究报告了个体危险因素的显著差异。
本综述表明，针对通过 CVD 风险评分选择的个体进行多因素干预有可能降低 CVD 风险和死亡率。然而，该领域的大多数研究并未提供足以显著降低 CVD 死亡率或经过验证的 CVD 风险的干预强度。
