采用极高危细化标准改善中国动脉粥样硬化性心血管疾病患者的评估：一项基于人群的研究
Improvement of evaluation in Chinese patients with atherosclerotic cardiovascular disease using the very-high-risk refinement: a population-based study.
作者信息
Li Sha, Liu Hui-Hui, Guo Yuan-Lin, Zhu Cheng-Gang, Wu Na-Qiong, Xu Rui-Xia, Dong Qian, Li Jian-Jun
机构信息
State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing 100037, China.
出版信息
Lancet Reg Health West Pac. 2021 Oct 21;17:100286. doi: 10.1016/j.lanwpc.2021.100286. eCollection 2021 Dec.
BACKGROUND
Continuous refinement of atherosclerotic cardiovascular disease (ASCVD) stratification has raised the definition of very-high-risk (VHR) recently, which has been underutilized in China. We aimed to identify patients at VHR and evaluate their performances in a Chinese population.
METHODS
A total of 9944 patients with ASCVD was continuously enrolled. Patients at VHR was identified according to 2018 AHA/ACC guideline. Median follow-up was 36.4 months. Clinical characteristics, low-density lipoprotein cholesterol (LDL-C) achievements, and the prognostic value of VHR mapping for cardiovascular events (CVEs) were evaluated.
FINDINGS
Overall, 26% (2542/9944) of patients were deemed as VHR, which were subsequently divided into two subgroups of VHR-1 [31% (779/2542)] and VHR-2 [69% (1763/2542)]. The rates of VHR were higher among patients of male (30%,2157/7268), young with age <45 years (46%,518/1130), and low-income regions (27%, 498/1838). Patients at VHR carried higher rates of risk factors than those at non-VHR (all p<0.001). However, only 3% (80/2542) of patients at VHR were prescribed with high-intensity of statins, and just 13% (321/2542) of them reached the LDL-C goal (<1.4mmol/L). Furthermore, of patients with coronary stenosis (n=9806), multiple-diseased vessels (47%, 1192/2523 36%,2587/7283) and occlusive lesions (36%, 902/2523 13%, 949/7283) were detected more commonly in those at VHR than non-VHR. The adjusted hazard ratios of VHR-1 and VHR-2 for primary CVEs were 2.58(1.61-4.14) and 2.23(1.55-3.20), respectively.
INTERPRETATION
Our study firstly reported that patients at VHR carried more severe ASCVD burden, lower LDL-C achievement, and higher CVEs risk, suggesting that the refinement of ASCVD might be considered in China to further understand patients at VHR.
FUNDING
Capital Health Development Fund and CAMS Major Collaborative Innovation Project.
背景
动脉粥样硬化性心血管疾病（ASCVD）分层的不断细化最近提高了极高风险（VHR）的定义，而这在中国尚未得到充分利用。我们旨在识别极高风险患者，并评估他们在中国人群中的情况。
方法
连续纳入9944例ASCVD患者。根据2018年美国心脏协会/美国心脏病学会指南识别极高风险患者。中位随访时间为36.4个月。评估临床特征、低密度脂蛋白胆固醇（LDL-C）达标情况以及极高风险分层对心血管事件（CVE）的预后价值。
结果
总体而言，26%（2542/9944）的患者被视为极高风险，随后分为极高风险-1[31%（779/2542）]和极高风险-2[69%（1763/2542）]两个亚组。男性患者（30%，2157/7268）、年龄<45岁的年轻患者（46%，518/1130）和低收入地区患者（27%，498/1838）的极高风险率更高。极高风险患者的危险因素发生率高于非极高风险患者（所有p<0.001）。然而，极高风险患者中只有3%（80/2542）接受了高强度他汀类药物治疗，只有13%（321/2542）达到了LDL-C目标（<1.4mmol/L）。此外，在有冠状动脉狭窄的患者（n=9806）中，多支血管病变（47%，1192/2523对36%，2587/7283）和闭塞性病变（36%，902/2523对13%，949/7283）在极高风险患者中比非极高风险患者更常见。极高风险-1和极高风险-2发生主要心血管事件的调整后风险比分别为2.58（1.61-4.14）和2.23（1.55-3.20）。
解读
我们的研究首次报告，极高风险患者的ASCVD负担更重，LDL-C达标率更低，心血管事件风险更高，这表明在中国可能需要考虑对ASCVD分层进行细化，以进一步了解极高风险患者。
资助
首都卫生发展基金和中国医学科学院重大协同创新项目。
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