Wagner Jeffrey R, Fitzpatrick Jesse K, Yang Jingrong, Sung Sue Hee, Allen Amanda R, Philip Sephy, Granowitz Craig, Abrahamson David, Ambrosy Andrew P, Go Alan S
Department of Internal Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA.
Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA.
Am J Prev Cardiol. 2022 Jan 29;9:100319. doi: 10.1016/j.ajpc.2022.100319. eCollection 2022 Mar.
Patients with risk factors for or established atherosclerotic cardiovascular disease (ASCVD) remain at high risk for subsequent ischemic events despite statin therapy. Triglyceride (TG) levels may contribute to residual ASCVD risk, and the performance of global risk assessment calculators across a broad range of TG levels is unknown.
We performed a retrospective cohort study of Kaiser Permanente Northern California members aged ≥45 years with ≥1 ASCVD risk factor (primary prevention cohort) or established ASCVD (secondary prevention cohort) between 2010 and 2017 who were receiving statin therapy and had a low-density lipoprotein cholesterol between 41-100 mg/dL. Global ASCVD risk assessment was performed using both the Kaiser Permanente ASCVD Risk Estimator (KPARE) and the ACC/AHA ASCVD Pooled Cohort Equation (PCE). Outcomes included major adverse cardiovascular events (MACE) defined as myocardial infarction, stroke, or peripheral artery disease, and expanded MACE (MACE + coronary revascularization + hospitalization for unstable angina).
Among 373,389 patients in the primary prevention cohort, median TG was 122 mg/dL (IQR 88-172 mg/dL) and there were 0.2 MACE events and 0.3 expanded MACE events per 100-person years. Among 97,832 patients in the secondary prevention cohort, median TG level was 116 mg/dL (IQR 84-164 mg/dL) and there were 9.6 MACE events and 22.0 expanded MACE events per 100-person years. KPARE and the ACC/AHA PCE stratified patients for MACE and expanded MACE over the entire range of TGs.
In a cohort receiving statin therapy for primary or secondary prevention, we found global assessment further improves risk stratification for initial and/or recurrent ASCVD events irrespective of baseline TG level.
尽管接受了他汀类药物治疗，但有动脉粥样硬化性心血管疾病（ASCVD）危险因素或已确诊ASCVD的患者，后续发生缺血性事件的风险仍然很高。甘油三酯（TG）水平可能导致残余的ASCVD风险，而在广泛的TG水平范围内全球风险评估计算器的性能尚不清楚。
我们对2010年至2017年间年龄≥45岁、有≥1个ASCVD危险因素（一级预防队列）或已确诊ASCVD（二级预防队列）、正在接受他汀类药物治疗且低密度脂蛋白胆固醇在41-100mg/dL之间的北加利福尼亚凯撒医疗集团成员进行了一项回顾性队列研究。使用凯撒医疗集团ASCVD风险评估器（KPARE）和美国心脏病学会/美国心脏协会ASCVD合并队列方程（PCE）进行全球ASCVD风险评估。结局包括定义为心肌梗死、中风或外周动脉疾病的主要不良心血管事件（MACE），以及扩展的MACE（MACE+冠状动脉血运重建+不稳定型心绞痛住院）。
在一级预防队列的373,389名患者中，TG中位数为122mg/dL（四分位间距88-172mg/dL），每100人年有0.2次MACE事件和0.3次扩展的MACE事件。在二级预防队列的97,832名患者中，TG中位数为116mg/dL（四分位间距84-164mg/dL），每100人年有9.6次MACE事件和22.0次扩展的MACE事件。KPARE和美国心脏病学会/美国心脏协会PCE在整个TG范围内对患者进行了MACE和扩展MACE分层。
在接受他汀类药物一级或二级预防治疗的队列中，我们发现全球评估进一步改善了初始和/或复发性ASCVD事件的风险分层，而与基线TG水平无关。
