Mortensen Martin B, Falk Erling
Atherosclerosis Research Unit, Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
BMJ Open. 2014 Oct 17;4(10):e005991. doi: 10.1136/bmjopen-2014-005991.
To determine the detection rate (sensitivity) of the high-risk strategy recommended in the European Society of Cardiology (ESC) and National Institute for Health and Care Excellence (NICE/UK) and American College of Cardiology/American Heart Association (ACC/AHA) guidelines on cardiovascular disease (CVD) prevention. In particular, to evaluate the ability to ensure statin therapy to contemporary Europeans destined for a first myocardial infarction (MI).
393 consecutive statin-naïve, CVD-free patients without diabetes hospitalised for a first MI, 247 of whom were 40-75 years of age. We assumed they had undergone a health check the day before their MI and estimated the predicted risk.
Sensitivity of the risk-based eligibility for primary prevention with statins recommended by the guidelines.
All recommended risk scores rank-ordered patients similarly, but the sensitivity of the cut point above which statin therapy should be considered differed substantially. In younger patients (age 40-60), 62% of men and 13% of women qualified for statin therapy by ACC/AHA criteria, compared with only 2% of men and no women using the ESC criteria recommended for most non-Eastern European countries. In those 60-75 years of age, the ACC/AHA guidelines captured all men and 85% of women, compared with 12% and 2%, respectively, using the new ESC guideline. This guideline restricted the eligibility for primary prevention with statins substantially by reclassifying many European countries from 'high-risk' to 'low-risk', whereas the eligibility was expanded in the ACC/AHA and the new NICE/UK guidelines by lowering the decision threshold.
The 2012 ESC guidelines differ substantially from the 2013 ACC/AHA and 2014 NICE/UK guidelines in ability to secure statin therapy to those destined for a first MI. A great opportunity for primary prevention with statins remains unexploited in Europe.
确定欧洲心脏病学会（ESC）、英国国家卫生与临床优化研究所（NICE/UK）以及美国心脏病学会/美国心脏协会（ACC/AHA）发布的心血管疾病（CVD）预防指南中所推荐的高风险策略的检出率（敏感性）。特别是，评估确保他汀类药物治疗适用于首次发生心肌梗死（MI）的当代欧洲人的能力。
393例首次因心肌梗死住院、未服用过他汀类药物且无糖尿病的连续CVD患者，其中247例年龄在40 - 75岁之间。我们假定他们在心肌梗死前一天接受了健康检查，并估算了预测风险。
指南推荐的基于风险的他汀类药物一级预防适用标准的敏感性。
所有推荐的风险评分对患者的排序相似，但应考虑使用他汀类药物治疗的切点敏感性差异很大。在较年轻患者（40 - 60岁）中，根据ACC/AHA标准，62%的男性和13%的女性符合他汀类药物治疗条件，而按照推荐给大多数非东欧国家的ESC标准，只有2%的男性和没有女性符合条件。在60 - 75岁人群中，ACC/AHA指南涵盖了所有男性和85%的女性，而按照新的ESC指南，分别为12%和2%。该指南通过将许多欧洲国家从“高风险”重新分类为“低风险”，大幅限制了他汀类药物一级预防的适用范围，而ACC/AHA和新的NICE/UK指南通过降低决策阈值扩大了适用范围。
2012年ESC指南在确保首次发生心肌梗死的患者接受他汀类药物治疗的能力方面，与2013年ACC/AHA指南和2014年NICE/UK指南存在显著差异。欧洲在他汀类药物一级预防方面仍有很大机会未得到利用。
