Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, California; Department of Epidemiology, School of Public Health, University of California, Los Angeles, California.
Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, California; Department of Epidemiology, School of Public Health, University of California, Los Angeles, California.
Am J Cardiol. 2020 Dec 15;137:7-11. doi: 10.1016/j.amjcard.2020.09.043. Epub 2020 Sep 28.
Despite statin therapy, many patients with atherosclerotic cardiovascular disease (ASCVD) still suffer from ASCVD events. Predictors of residual ASCVD risk are not well-delineated. We aimed to develop an ASCVD risk prediction model for patients with previous ASCVD on statin use. We utilized statin-treated patients with ASCVD from the AIM-HIGH trial cohort. A 5-year risk score for subsequent ASCVD events with known ASCVD was developed using Cox regression, including potential risk factors with age, sex, and race forced in the model. Internal discrimination and calibration were evaluated. We included 3,271 patients with ASCVD (85.4% male, mean age 63.6 years, 65% on moderate- and 24% on high-intensity statin) with complete risk factor data and mean follow-up of 4.18 years. Overall, the estimated 5-year ASCVD risk was 21.1%: 10.2% of patients had a 5-year risk of >30%, and 38.8% had risk of between 20% and 30%. In the model, male sex, hemoglobin A1c, alcohol use (inversely), family history of cardiovascular disease, homocysteine, history of carotid artery disease, and lipoprotein(a) best predicted residual ASCVD risk. Niacin treatment status did not enter the model. A C-statistic of 0.59 was obtained, with the Greenwood-Nam-D'Agostino test showing excellent calibration. We developed a risk prediction risk model for predicting 5-year residual ASCVD risk in statin-treated patients with known ASCVD that may help in identifying such persons at the highest risk of recurrent events. Validation in larger samples with patients on high-intensity statin is needed.
尽管进行了他汀类药物治疗，许多患有动脉粥样硬化性心血管疾病（ASCVD）的患者仍会发生 ASCVD 事件。残留 ASCVD 风险的预测因素尚未明确。我们旨在为使用他汀类药物治疗的既往有 ASCVD 的患者开发一种 ASCVD 风险预测模型。我们利用 AIM-HIGH 试验队列中接受他汀类药物治疗的 ASCVD 患者。使用 Cox 回归为已知 ASCVD 的患者开发了一个 5 年 ASCVD 事件的风险评分，模型中包含年龄、性别和种族等潜在风险因素。评估了内部区分度和校准度。我们纳入了 3271 例 ASCVD 患者（85.4%为男性，平均年龄 63.6 岁，65%接受中等强度他汀类药物治疗，24%接受高强度他汀类药物治疗），这些患者具有完整的风险因素数据和平均 4.18 年的随访。总体而言，估计的 5 年 ASCVD 风险为 21.1%：10.2%的患者有 5 年风险>30%，38.8%的患者风险在 20%至 30%之间。在该模型中，男性性别、糖化血红蛋白、饮酒（反之亦然）、心血管疾病家族史、同型半胱氨酸、颈动脉疾病史和脂蛋白（a）可最好地预测残留 ASCVD 风险。烟酸治疗状况未纳入模型。C 统计量为 0.59，Greenwood-Nam-D'Agostino 检验显示校准效果良好。我们开发了一种风险预测模型，用于预测已知 ASCVD 的他汀类药物治疗患者的 5 年残留 ASCVD 风险，这可能有助于识别复发风险最高的患者。需要在接受高强度他汀类药物治疗的患者中进行更大样本的验证。
