Brotons Carlos, Calvo-Bonacho Eva, Moral Irene, Puig Mireia, Garcia-Margallo María T, Cortés-Arcas María V, Catalina-Romero Carlos, Quevedo-Aguado Luis, Ruilope Luis M
Research Unit, Sardenya Primary Health Care Centre-Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain Teaching Unit of Family Medicine ACEBA, Barcelona, Spain
Ibermutuamur, Madrid, Spain.
Eur J Prev Cardiol. 2016 Apr;23(6):564-71. doi: 10.1177/2047487315579616. Epub 2015 Mar 31.
Recent guidelines recommend assessment of lifetime cardiovascular risk on the basis of traditional risk factors in adults who are not at high short-term risk. The aim of this study is to determine the implications of estimating the lifetime cardiovascular risk in individuals in a large occupational cohort in Spain.
National cross-sectional study in an occupational cohort with an in-person interview including laboratory tests.
Volunteer workers who were examined between January 2011 and December 2011 were included. A total of 580,236 workers were eligible during this year and 259,834 were examined (participation rate of 44.7%). Short-term (10-year) and lifetime cardiovascular risk were estimated using the American College of Cardiology (ACC) and the American Heart Association (AHA) tool and the QRISK2 and QRISK.
Sixty-eight per cent were male, mean age was 39 years, with an age range of 16 to 75 years. Total number of individuals included in this study was 258,676. The percentage of patients at high short-term risk was 6.85% (95% confidence interval (CI) 6.75%-6.95% and 20.83% (95% CI 20.60%-21.07%) with the QRISK2, and the ACC/AHA risk equations, respectively. Of the percentage of patients classified as not at high risk with the different tools 1.61% (95% CI 1.55%-1.66%) were high lifetime risk on QRISK, and 27.41% (95% CI 27.11%-27.70%) on ACC/AHA risk.
Application of lifetime cardiovascular risk engages greater numbers of individuals at high risk with substantial differences between the different methods available. These differences can have important clinical implications specifically in the percentage of candidates for lifestyle changes and eventually lipid lowering drugs.
近期指南建议，对于短期风险不高的成年人，应根据传统风险因素评估终生心血管风险。本研究的目的是确定在西班牙一个大型职业队列中估计个体终生心血管风险的意义。
在一个职业队列中进行的全国性横断面研究，包括面对面访谈和实验室检查。
纳入2011年1月至2011年12月期间接受检查的志愿工作者。该年度共有580,236名工作者符合条件，259,834人接受了检查（参与率为44.7%）。使用美国心脏病学会（ACC）和美国心脏协会（AHA）工具以及QRISK2和QRISK估计短期（10年）和终生心血管风险。
68%为男性，平均年龄39岁，年龄范围为16至75岁。本研究纳入的个体总数为258,676人。短期高风险患者的百分比分别为6.85%（95%置信区间（CI）6.75%-6.95%）和20.83%（95%CI 20.60%-21.07%），分别使用QRISK2和ACC/AHA风险方程。在被不同工具分类为非高风险的患者百分比中，使用QRISK时1.61%（95%CI 1.55%-1.66%）为高终生风险，使用ACC/AHA风险时为27.41%（95%CI 27.11%-27.70%）。
终生心血管风险的应用使更多个体处于高风险状态，不同可用方法之间存在实质性差异。这些差异可能具有重要的临床意义，特别是在生活方式改变候选者以及最终降脂药物的百分比方面。
