Sección de Cardiología, Hospital Universitario de San Juan de Alicante, San Juan de Alicante, Alicante, Spain; Departamento de Medicina Clínica, Universidad Miguel Hernández, Campus de San Juan, Alicante, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV CB16/11/00420), Madrid, Spain.
Centro de Salud de Muchamiel, Departamento de Salud San Juan de Alicante, Muchamiel, Alicante, Spain.
Atherosclerosis. 2019 Nov;290:80-86. doi: 10.1016/j.atherosclerosis.2019.09.007. Epub 2019 Sep 23.
Cholesterol treatment for the primary prevention of cardiovascular disease is based on cardiovascular risk, as assessed by the SCORE (Systematic COronary Risk Evaluation) scale. This study aimed to assess the predictive value and clinical utility of the SCORE scale for preventing cardiovascular events and all-cause mortality in people with dyslipidemia and no lipid-lowering treatment.
Patients with dyslipidemia and no lipid-lowering treatment were included from the ESCARVAL-RISK cohort. Cardiovascular risk was calculated by means of the SCORE scale. All deaths and cardiovascular events were recorded for up to five years of follow-up. We calculated sensitivity, specificity and other predictive values for different cut-off points and assessed the effect of different risk factors on the diagnostic accuracy of the SCORE charts.
In the final cohort of 18,853 patients, there were 1565 cardiovascular events and 268 deaths. The risk value recommended to initiate pharmacological treatment (5%) presented a specificity of 86% for death and 90% for cardiovascular events, and a sensitivity of 53% for death and 32% for cardiovascular events. In addition, the scale classified as low risk 62.8% of the patients who suffered a cardiovascular event and 46.6% of those who died. Antithrombotic treatment, diabetes, hypertension, heart failure, peripheral artery disease and chronic kidney disease were associated with a reduction in the predictive capability of the SCORE scale, whereas metabolic syndrome was related to better risk prediction.
The predictive capability of the SCORE scale for cardiovascular disease and total mortality in patients with dyslipidemia is limited.
心血管疾病一级预防的胆固醇治疗基于心血管风险，通过 SCORE（系统性冠状动脉风险评估）量表评估。本研究旨在评估 SCORE 量表在预测血脂异常且未接受降脂治疗的人群发生心血管事件和全因死亡率方面的预测价值和临床实用性。
从 ESCARVAL-RISK 队列中纳入血脂异常且未接受降脂治疗的患者。通过 SCORE 量表计算心血管风险。记录了长达五年的随访期间的所有死亡和心血管事件。我们计算了不同截断值的敏感性、特异性和其他预测值，并评估了不同危险因素对 SCORE 图表诊断准确性的影响。
在最终的 18853 例患者队列中，有 1565 例心血管事件和 268 例死亡。建议开始药物治疗的风险值（5%）对死亡的特异性为 86%，对心血管事件的特异性为 90%，对死亡的敏感性为 53%，对心血管事件的敏感性为 32%。此外，该量表将 62.8%的发生心血管事件和 46.6%的死亡患者归类为低风险。抗血栓治疗、糖尿病、高血压、心力衰竭、外周动脉疾病和慢性肾脏病与 SCORE 量表预测能力的降低有关，而代谢综合征与更好的风险预测相关。
SCORE 量表对血脂异常患者的心血管疾病和全因死亡率的预测能力有限。
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