Fédération de cardiologie, Hôpital de la Croix-Rousse et Hôpital Lyon Sud, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, F-69004 Lyon, France.
Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Lyon, France.
Eur J Prev Cardiol. 2022 Feb 19;29(1):136-143. doi: 10.1093/eurjpc/zwaa163.
Current European guidelines recommend the SCORE to estimate 10-year cardiovascular mortality in patients with moderate/low cardiovascular risk. SCORE was derived from the general population. The objective of this study was to investigate the estimated 10-year cardiovascular mortality according to the SCORE in a historic and a contemporary cohort of hypertensive patients.
After exclusion of secondary prevention and diabetes, 3086 patients were analysed in the OLD-HTA (1969-90) and 1081 in the NEW-HTA (1997-2014) Lyon cohorts. SCORE was calculated using the low and high cardiovascular risk equations and charts, and patients classified as being at low (0%), moderate (1-4%), high (5-9%), and very high (≥10%) risk. In the OLD-HTA cohort, 10-year cardiovascular mortality was higher (1.2%, 5.5%, 17.7%, and 27.0%) than that predicted by the low-risk equation (0%, 1.7%, 6.4%, and 14.8%). In the NEW-HTA cohort, similar results were observed (1.1%, 4.7%, 15.1%, and 15.2% vs. 0%, 1.9%, 6.2%, and 11.7%, respectively). Using the high-risk equation, mortality was underestimated in both cohorts, but the difference was smaller. The diagnostic performance of the high-risk equation was lower than the low-risk equation in both cohorts, considering the SCORE as a continuous or a categorical variable (Likelihood ratio test P < 0.05 for all comparisons in OLD-HTA). Similar results were obtained using SCORE charts.
SCORE underestimates the 10-year cardiovascular mortality risk in hypertensive patients in a historic cohort and in a contemporary one. The algorithm to predict cardiovascular mortality in hypertensive patients needs an update given new information since its creation.
目前的欧洲指南建议使用 SCORE 来估计中低心血管风险患者的 10 年心血管死亡率。SCORE 源自普通人群。本研究的目的是调查历史队列和当代队列的高血压患者中根据 SCORE 估算的 10 年心血管死亡率。
排除二级预防和糖尿病后，对 OLD-HTA（1969-90 年）队列中的 3086 例患者和 NEW-HTA（1997-2014 年）里昂队列中的 1081 例患者进行分析。使用低危和高危心血管风险方程和图表计算 SCORE，并将患者分为低危（0%）、中危（1-4%）、高危（5-9%）和极高危（≥10%）。在 OLD-HTA 队列中，10 年心血管死亡率（1.2%、5.5%、17.7%和 27.0%）高于低危方程预测值（0%、1.7%、6.4%和 14.8%）。在 NEW-HTA 队列中，也观察到类似的结果（1.1%、4.7%、15.1%和 15.2%与 0%、1.9%、6.2%和 11.7%）。在两个队列中，使用高危方程均低估了死亡率，但差异较小。在两个队列中，无论将 SCORE 视为连续变量还是分类变量，高危方程的诊断性能均低于低危方程（OLD-HTA 中所有比较的似然比检验 P<0.05）。使用 SCORE 图表也得到了类似的结果。
SCORE 低估了历史队列和当代队列中高血压患者的 10 年心血管死亡率风险。鉴于自创建以来有了新的信息，用于预测高血压患者心血管死亡率的算法需要更新。
