Trinity College, Dublin, Ireland.
Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
J Am Coll Cardiol. 2021 Jun 22;77(24):3046-3057. doi: 10.1016/j.jacc.2021.04.052.
Clinical estimation of the combined effect of several risk factors is unreliable and this resulted in the development of a number of risk estimation systems to guide clinical practice. Here, after defining general principles of risk estimation, the authors describe the evolution of the European Society of Cardiology's (ESC) Systematic COronary Risk Evaluation (SCORE) risk estimation system and some learnings from the data. They move on to describe the establishment of the ESC's Cardiovascular Risk Collaboration and outline its proposed research directions. First among these is the evolution of SCORE 2, which provides updated, calibrated risk estimates for total cardiovascular events for low, moderate, high, and very high-risk regions of Europe. The authors conclude by considering that the future of risk estimation may be to express risk as years of exposure to a cardiovascular risk factor profile rather than risk over a fixed time period, such as 10 years, and how advances in genetics may permit individualized lifetime risk estimation from childhood on.
临床评估多个风险因素的综合效应是不可靠的，这导致了许多风险评估系统的发展，以指导临床实践。在这里，在定义了风险评估的一般原则之后，作者描述了欧洲心脏病学会（ESC）系统冠状动脉风险评估（SCORE）风险评估系统的发展，以及一些数据中的经验教训。他们接着描述了 ESC 心血管风险合作组织的建立，并概述了其拟议的研究方向。其中首先是 SCORE 2 的发展，它为欧洲低、中、高和极高风险地区的总心血管事件提供了更新的、校准的风险估计。作者最后认为，风险评估的未来可能是将风险表示为暴露于心血管风险因素谱的年限，而不是固定时间段（如 10 年）的风险，以及遗传学的进步如何能够允许从儿童时期开始对个体的终生风险进行估计。
