Evidence-Based Medicine, Department of Family Medicine, University of Alberta, Room 1706 College Plaza, 8215-112 St NW, Edmonton, Alberta T6G 2C8, Canada.
Circulation. 2013 May 14;127(19):1948-56. doi: 10.1161/CIRCULATIONAHA.112.000412. Epub 2013 Apr 10.
Use of cardiovascular disease risk calculators is often recommended by guidelines, but research on consistency in risk assessment among calculators is limited.
A search of PubMed and Google was performed. Five clinicians selected 25 calculators by independent review. Hypothetical patients were created with the use of 7 risk factors (age, sex, smoking, blood pressure, high-density lipoprotein, total cholesterol, and diabetes mellitus) dichotomized to high and low, generating 2(7) patients (128 total). These patients were assessed by each calculator by 2 clinicians. Risk estimates (and assigned risk categories) were compared among calculators. Selected calculators were from 8 countries, used 5- or 10-year predictions, and estimated either cardiovascular disease or coronary heart disease. With the use of 3 risk categories (low, medium, and high), the 25 calculators categorized each patient into a mean of 2.2 different categories, and 41% of unique patients were assigned across all 3 risk categories. Risk category agreement between pairs of calculators was 67%. This did not improve when analysis was limited to just the 10-year cardiovascular disease calculators. In nondiabetics, the highest calculated risk estimate from a calculator averaged 4.9 times higher (range, 1.9-13.3) than the lowest calculated risk estimate for the same patient. This did not change meaningfully for diabetics or when the analysis was limited to 10-year cardiovascular disease calculators.
The decision as to which calculator to use for risk estimation has an important impact on both risk categorization and absolute risk estimates. This has broad implications for guidelines recommending therapies based on specific calculators.
心血管疾病风险计算器的使用通常是由指南推荐的，但对计算器之间风险评估一致性的研究是有限的。
对 PubMed 和 Google 进行了检索。五位临床医生通过独立审查选择了 25 个计算器。使用 7 个风险因素（年龄、性别、吸烟、血压、高密度脂蛋白、总胆固醇和糖尿病）将每个患者分为高和低两种情况，生成了 2（7）个患者（共 128 个）。由两位临床医生使用这些计算器对每个患者进行评估。比较了计算器之间的风险估计值（和分配的风险类别）。选定的计算器来自 8 个国家，使用 5 年或 10 年的预测，并估计心血管疾病或冠心病。使用 3 个风险类别（低、中、高），25 个计算器将每个患者平均分为 2.2 个不同的类别，41%的独特患者被分配到所有 3 个风险类别。计算器对之间的风险类别一致性为 67%。当分析仅限于仅 10 年心血管疾病计算器时，这种一致性并没有提高。在非糖尿病患者中，计算器计算的最高风险估计值平均比同一患者计算的最低风险估计值高出 4.9 倍（范围 1.9-13.3）。对于糖尿病患者或当分析仅限于 10 年心血管疾病计算器时，这并没有显著改变。
用于风险估计的计算器的选择对风险分类和绝对风险估计都有重要影响。这对基于特定计算器推荐治疗方案的指南有广泛的影响。
