1 Clalit Health Services, Tel Aviv District, Israel.
2 Department of Family Medicine, Rabin Medical Center, Israel.
Eur J Prev Cardiol. 2018 May;25(8):870-880. doi: 10.1177/2047487318763825. Epub 2018 Mar 8.
Aims The aim of this study was to evaluate the performance of the US Preventive Services Task Force (USPSTF) cholesterol recommendations in a contemporary non-US cohort. Methods and results This is a historical cohort analysis of electronic records from Israel's largest health provider. All patients in the Tel Aviv district eligible for primary cardiovascular prevention were followed between January 2005 and December 2015. Risk was estimated by the pooled cohort equations. Statin eligibility was determined by USPSTF and American College of Cardiology and American Heart Association (ACC/AHA) recommendations. Atherosclerotic cardiovascular disease events were retrieved from electronic registration. The mean ± standard deviation age of the 10,889 (98,258 person-years) participants was 60.3 ± 9.4 years, and 69.1% were women. Outcome events were recorded for 1351 patients (12.4%). Treatment recommendations were discordant in 901 patients (8.3%) whose treatment was indicated only by the ACC/AHA guidelines, implying a 26% reduction in newly eligible patients for statin treatment had the USPSTF recommendations been implemented. Among the statin-naive patients, the pooled cohort equations underestimated the risk, with a predicted-to-observed event ratio of 0.88. The recommended treatment thresholds provided excellent calibration, with ratios of 1.0 for USPSTF and 0.98 for ACC/AHA-eligible patients. Both models showed similar discrimination (Harrel's C = 0.63 (0.62-0.65) for USPSTF vs. 0.64 (0.63-0.66) for ACC/AHA, P = 0.26). The USPSTF recommendations were less sensitive and more specific for the detection of outcome events than the ACC/AHA recommendations (61% vs. 75% and 68% vs. 55%, respectively). The net reclassification index was -0.01. Conclusions Calibration, discrimination and net reclassifications were very similar for USPSTF and ACC/AHA recommendations. Applying the USPSTF recommendations could reduce over-treatment.
目的 本研究旨在评估美国预防服务工作组（USPSTF）的胆固醇建议在当代非美国队列中的表现。
方法和结果 这是一项对以色列最大医疗保健提供者的电子记录进行的历史队列分析。2005 年 1 月至 2015 年 12 月期间，塔勒夫地区所有符合一级心血管预防条件的患者均参与本研究。风险通过汇总队列方程进行评估。他汀类药物的适用性根据 USPSTF 和美国心脏病学会和美国心脏协会（ACC/AHA）的建议确定。从电子登记处检索动脉粥样硬化性心血管疾病事件。10889 名（98258 人年）参与者的平均年龄为 60.3±9.4 岁，69.1%为女性。记录了 1351 名患者（12.4%）的结局事件。901 名患者（8.3%）的治疗建议不一致，这些患者的治疗仅符合 ACC/AHA 指南，这意味着如果实施 USPSTF 建议，新符合他汀类药物治疗条件的患者将减少 26%。在他汀类药物治疗的患者中，汇总队列方程低估了风险，预测到观察到的事件比值为 0.88。推荐的治疗阈值具有极好的校准度，USPSTF 的比值为 1.0，ACC/AHA 合格患者的比值为 0.98。两个模型的区分度均相似（USPSTF 为 0.63（0.62-0.65），ACC/AHA 为 0.64（0.63-0.66），P=0.26）。USPSTF 建议在检测结局事件方面的敏感性低于 ACC/AHA 建议（分别为 61%和 75%，68%和 55%），特异性较高（分别为 68%和 55%）。净重新分类指数为-0.01。
结论 USPSTF 和 ACC/AHA 建议的校准度、区分度和净重新分类指数非常相似。应用 USPSTF 建议可以减少过度治疗。
