英国与复发性事件或多血管动脉粥样硬化性心血管疾病相关的增加风险的估计。
Estimation of the increased risk associated with recurrent events or polyvascular atherosclerotic cardiovascular disease in the United Kingdom.
机构信息
Outcomes Insights, Inc., USA.
Amgen (Europe) GmbH, Switzerland.
出版信息
Eur J Prev Cardiol. 2021 Apr 23;28(3):335-343. doi: 10.1177/2047487319899212. Epub 2020 Jan 21.
AIMS
The aims of this study were to re-estimate the international REduction of Atherothrombosis for Continued Health (REACH) risk equation using United Kingdom data and to distinguish different relative hazards for specific atherosclerotic cardiovascular disease event histories.
METHODS AND RESULTS
Patients in the UK Clinical Research Practice Datalink (CPRD) were included as of 1 January 2005 if they were 40 years or older, had 2 or more years of prior data, received one or more moderate or high-intensity statin in the previous year, and had a history of myocardial infarction, ischemic stroke, or other atherosclerotic cardiovascular disease. Patients were followed until a composite endpoint of myocardial infarction, ischemic stroke or cardiovascular death, loss to follow-up, or end of observation. We re-estimated the REACH risk equation hazard ratios (HRs) using CPRD data (re-estimated REACH model). Our event history model replaced the REACH vascular bed variables with more specific event histories. There were 60,838 patients with 5.25 years of mean follow-up. In the validation model, HRs were in the same direction, and generally greater than REACH. In the event history model, HRs compared to other atherosclerotic cardiovascular disease alone included: recurrent myocardial infarction (HR 1.19, 95% confidence interval (CI) 1.05-1.34), recurrent ischemic stroke (HR 1.36, 95% CI 1.03-1.80), myocardial infarction and other atherosclerotic cardiovascular disease (HR 1.31, 95% CI 1.23-1.38), ischemic stroke and other atherosclerotic cardiovascular disease (HR 1.40, 95% CI 1.23-1.60), myocardial infarction and ischemic stroke (HR 1.94, 95% CI 1.23-3.04), and myocardial infarction, ischemic stroke and other atherosclerotic cardiovascular disease (HR 1.93, 95% CI 1.47-2.54).
CONCLUSION
A detailed cardiovascular event history may be useful for estimating the relative risk of future cardiovascular events.
目的
本研究旨在使用英国数据重新估算国际动脉粥样硬化血栓形成减少以持续健康（REACH）风险方程，并区分特定动脉粥样硬化性心血管疾病病史的不同相对风险。
方法和结果
如果患者年龄在 40 岁或以上，有 2 年或以上的既往数据，在前一年接受过一种或多种中等强度或高强度他汀类药物治疗，并且有心肌梗死、缺血性中风或其他动脉粥样硬化性心血管疾病的病史，则从 2005 年 1 月 1 日起纳入英国临床研究实践数据库（CPRD）。患者随访至心肌梗死、缺血性中风或心血管死亡、失访或观察结束的复合终点。我们使用 CPRD 数据重新估算了 REACH 风险方程的危险比（HRs）（重新估算的 REACH 模型）。我们的事件史模型用更具体的事件史取代了 REACH 血管床变量。共有 60838 例患者，平均随访时间为 5.25 年。在验证模型中，HRs 的方向相同，且通常大于 REACH。在事件史模型中，与单独的其他动脉粥样硬化性心血管疾病相比，HRs 包括：复发性心肌梗死（HR 1.19，95%置信区间（CI）1.05-1.34）、复发性缺血性中风（HR 1.36，95%CI 1.03-1.80）、心肌梗死和其他动脉粥样硬化性心血管疾病（HR 1.31，95%CI 1.23-1.38）、缺血性中风和其他动脉粥样硬化性心血管疾病（HR 1.40，95%CI 1.23-1.60）、心肌梗死和缺血性中风（HR 1.94，95%CI 1.23-3.04）以及心肌梗死、缺血性中风和其他动脉粥样硬化性心血管疾病（HR 1.93，95%CI 1.47-2.54）。
结论
详细的心血管事件史可能有助于估计未来心血管事件的相对风险。
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