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预测亚临床动脉粥样硬化的风险评分比较

[Comparison of risk scores to predict subclinical atherosclerosis].

作者信息

Moreyra Eduardo, Lorenzatti Daniel, Moreyra Camila, Arias Viviana, Tibaldi Miguel A, Lepori Augusto J, Sarmiento Pablo, Moreyra Eduardo A

机构信息

Servicio de Cardiología, Sanatorio Allende, Córdoba, Argentina. E-mail:

Servicio de Cardiología, Sanatorio Allende, Córdoba, Argentina.

出版信息

Medicina (B Aires). 2019;79(5):373-383.

Abstract

Subclinical atherosclerosis is a powerful predictor of cardiovascular events, although it is unknown which of the risk scores is more useful to predict its presence in a Latin American population. The objective was to compare the performance of the risk scores: Framingham, Regicor and Atherosclerotic Cardiovascular Disease Risk Estimator to predict the presence of subclinical atherosclerosis in asymptomatic persons without known cardiovascular disease; as well as determining its prevalence and distribution in the different vascular beds. From 2014 to 2017, patients from 35 to 75 years, asymptomatic and without known cardiovascular disease who underwent a carotid and femoral Doppler echo and calcium score were evaluated. Subclinical atherosclerosis was defined as the presence of plaques in the carotid and/or femoral arteries or the presence of calcium in the coronary arteries (Agatston score > 0). A total of 212 patients were included. The mean age was 53 ± 7 years, of which 60% (128) were male. The prevalence of subclinical atherosclerosis was 62% (131 cases). Of these 131 subjects with a plaque in any of the territories, the Atherosclerotic Cardiovascular Disease Risk Estimator was the one that identified the highest number of cases with high cardiovascular risk (39%), Framingham detected 20%, and Regicor 0% (p < 0.01). The net reclassification was 41%, 50% and 60% respectively (< 0.01). The prevalence of subclinical atherosclerosis in asymptomatic persons without a history of cardiovascular disease was 62%. The Atherosclerotic Cardiovascular Disease Risk Estimator was the most effective predictor of subclinical atherosclerosis in this population.

摘要

亚临床动脉粥样硬化是心血管事件的有力预测指标,尽管尚不清楚哪种风险评分在预测拉丁裔人群中该疾病的存在方面更有用。目的是比较风险评分(弗雷明汉、雷吉科尔和动脉粥样硬化性心血管疾病风险评估器)在预测无已知心血管疾病的无症状人群中亚临床动脉粥样硬化存在情况方面的表现;并确定其在不同血管床中的患病率和分布情况。2014年至2017年,对年龄在35至75岁、无症状且无已知心血管疾病、接受过颈动脉和股动脉多普勒超声及钙化积分检查的患者进行了评估。亚临床动脉粥样硬化定义为颈动脉和/或股动脉存在斑块或冠状动脉存在钙化(阿加斯顿评分>0)。共纳入212例患者。平均年龄为53±7岁,其中60%(128例)为男性。亚临床动脉粥样硬化的患病率为62%(131例)。在这131例在任何区域有斑块的受试者中,动脉粥样硬化性心血管疾病风险评估器识别出心血管高风险病例的数量最多(39%),弗雷明汉检测出20%,雷吉科尔检测出0%(p<0.01)。净重新分类分别为41%、50%和60%(<0.01)。无心血管疾病病史的无症状人群中亚临床动脉粥样硬化的患病率为62%。在该人群中,动脉粥样硬化性心血管疾病风险评估器是亚临床动脉粥样硬化最有效的预测指标。

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