Anthony David, George Paul, Eaton Charles B
Memorial Hospital of Rhode Island, 111 Brewster St, Pawtucket, RI 02903,
Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903,
FP Essent. 2014 Jun;421:11-5.
Current guidelines recommend global risk assessment instruments as the primary approach for determining risk of coronary heart disease (CHD). The Framingham Risk Score (FRS) yields a 10-year risk of CHD, whereas the newer Pooled Cohort Equations yield a 10-year risk of stroke or CHD. High-sensitivity C-reactive protein, a biomarker for inflammation, along with family history of CHD, can be added to the parameters of the FRS in the Reynolds Risk Score to yield a more refined 10-year CHD risk. Various other biomarkers also can be used. Patients with elevated urinary albumin have higher rates of CHD events, though the incremental yield of adding urinary albumin provides only minor improvements in risk assessment compared with the FRS. Elevated levels of lipoprotein (a) [Lp(a)] also predict increased risk of CHD, and some guidelines recommend Lp(a) testing for patients with strong family histories of premature CHD. Another biomarker is platelet-activating factor acetylhydrolase (Lp-PLA2). Elevated levels indicate increased risk, and some recommendations suggest a lower goal level for low-density lipoprotein with statin therapy when Lp-PLA2 levels are high. Finally, genome-wide association studies for genetic risk of CHD currently are not recommended, but such tests likely will be useful within the next few years.
当前指南推荐使用全球风险评估工具作为确定冠心病（CHD）风险的主要方法。弗明汉风险评分（FRS）得出冠心病的10年风险，而更新的合并队列方程得出中风或冠心病的10年风险。高敏C反应蛋白，一种炎症生物标志物，连同冠心病家族史，可添加到雷诺兹风险评分中FRS的参数里，以得出更精确的冠心病10年风险。还可使用各种其他生物标志物。尿白蛋白升高的患者冠心病事件发生率更高，不过与FRS相比，添加尿白蛋白的额外收益在风险评估中仅带来微小改善。脂蛋白（a）[Lp（a）]水平升高也预示冠心病风险增加，一些指南建议对有早发性冠心病家族史的患者进行Lp（a）检测。另一种生物标志物是血小板活化因子乙酰水解酶（Lp-PLA2）。水平升高表明风险增加，一些建议提出当Lp-PLA2水平较高时，他汀类药物治疗的低密度脂蛋白目标水平应更低。最后，目前不推荐进行冠心病遗传风险的全基因组关联研究，但此类检测在未来几年可能会有用。
