Shlomai Gadi, Shemesh Joseph, Segev Shlomo, Koren-Morag Nira, Grossman Ehud
Department of Internal Medicine D and Hypertension Unit, Chaim Sheba Medical Center, Ramat Gan, Israel.
The Division of Endocrinology, Diabetes and Metabolism, Chaim Sheba Medical Center, Ramat Gan, Israel.
Front Cardiovasc Med. 2022 Jul 15;9:855390. doi: 10.3389/fcvm.2022.855390. eCollection 2022.
The current categorization of cardiovascular (CV) risk broadens the indications for statin therapy. Coronary artery calcium (CAC) identifies those who are most likely to benefit from primary prevention with statin therapy. The multi-ethnic study of atherosclerosis-calcium (MESA-C) includes CAC for CV risk stratification.
We aimed to establish whether the MESA-C score improves allocation to statin treatment in a cohort of asymptomatic adults. We also analyzed patient survival according to their risk score calculation.
A retrospective analysis of asymptomatic adults.
A total of 632 consecutive subjects free of coronary artery disease (CAD) and/or stroke, mean age 56 ± 7 years, 84% male, underwent clinical evaluations and CAC measurements.
PCE and MESA-C risk scores were calculated for each subject. According to the 10-year risk for CV events, subjects were classified into moderate and high CV risk (≥7.5%) for whom a statin is clearly indicated, or borderline and low CV risk (<7.5%).
During mean follow-up of 6.5 ± 3.3 years, 52 subjects experienced their first CV event. Those with a MESA-C risk score < 7.5% had favorable outcomes even when the PCE indicated a risk of ≥ 7.5%. The MESA-C score improved the discrimination of CV risk with the ROC curves C-statistics increasing from 0.653 for the PCE to 0.770 for the MESA-C. Of those, 84% (99/118) with borderline CV risk (5-7.5%) according to the PCE score, were reallocated by the MESA-C score into a higher (≥7.5%) or lower (<5%) CV risk category. Furthermore, subjects with low MESA-C scores had the highest survival rate regardless of the PCE risk, while those with high MESA-C risks had the lowest survival rate regardless of the PCE risk.
In asymptomatic subjects, the MESA-C score improves allocation to statin treatment and CV risk discrimination, while both scores are essential for more precise survival estimations.
当前心血管（CV）风险分类扩大了他汀类药物治疗的适应症。冠状动脉钙化（CAC）可识别出最有可能从他汀类药物一级预防中获益的人群。动脉粥样硬化-钙多族裔研究（MESA-C）将CAC纳入CV风险分层。
我们旨在确定MESA-C评分是否能改善无症状成年人队列中他汀类药物治疗的分配。我们还根据风险评分计算分析了患者生存率。
对无症状成年人进行回顾性分析。
共有632名连续的无冠状动脉疾病（CAD）和/或中风的受试者，平均年龄56±7岁，84%为男性，接受了临床评估和CAC测量。
为每个受试者计算PCE和MESA-C风险评分。根据CV事件的10年风险，将受试者分为明确需要使用他汀类药物的中度和高度CV风险（≥7.5%），或临界和低度CV风险（<7.5%）。
在平均6.5±3.3年的随访期间，52名受试者经历了首次CV事件。即使PCE显示风险≥7.5%，MESA-C风险评分<7.5%的受试者仍有良好的预后。MESA-C评分改善了CV风险的辨别能力，ROC曲线C统计量从PCE的0.653增加到MESA-C的0.770。其中，根据PCE评分处于临界CV风险（5-7.5%）的受试者中，84%（99/118）被MESA-C评分重新分类为更高（≥7.5%）或更低（<5%）的CV风险类别。此外，无论PCE风险如何，MESA-C评分低的受试者生存率最高，而MESA-C风险高的受试者生存率最低。
在无症状受试者中，MESA-C评分改善了他汀类药物治疗的分配和CV风险辨别能力，而这两个评分对于更精确的生存估计都至关重要。
