Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea (I.-C.H., H.-M.C., Y.E.Y., G.-Y.C.).
Department of Internal Medicine, Seoul National University College of Medicine, South Korea (I.-C.H., H.-M.C., Y.E.Y., G.-Y.C.).
Hypertension. 2023 Aug;80(8):1697-1706. doi: 10.1161/HYPERTENSIONAHA.122.20678. Epub 2023 May 31.
Contemporary cardiovascular primary prevention is based on the assessment of the 10-year risk of atherosclerotic cardiovascular disease (ASCVD). However, the clinical implications of temporal change in the 10-year ASCVD risk estimate (∆10-year ASCVD risk/year) are unknown.
A total of 211 077 participants without established ASCVD and with repetitive 10-year ASCVD risk assessment at an interval of 4 to 5 years were selected from the Korean National Health Insurance Service data. The primary end point was a composite of myocardial infarction, stroke, coronary revascularization, and all-cause death.
ASCVD event rates were proportional to the ∆10-year ASCVD risk/year regardless of the baseline 10-year ASCVD risk. Adjusted hazard ratio for ASCVD events per 1% increase in ∆10-year ASCVD risk/year was 1.53 (95% CI, 1.44-1.63), 1.24 (95% CI, 1.15-1.32), 1.18 (95% CI, 1.13-1.23), and 1.05 (95% CI, 1.00-1.10) in those with a baseline 10-year ASCVD risk of <5%, 5% to 7.5%, 7.5% to 20%, and ≥20%, respectively. Appropriate control of risk factors, including low-density lipoprotein cholesterol, blood pressure, body mass index, exercise habits, and smoking status, was associated with lower ASCVD event rates, whereas failure to control these risk factors resulted in higher ASCVD event rates.
The temporal change in 10-year ASCVD risk over a period of 4 to 5 years reflects success or failure in controlling major cardiovascular risk factors and indicates the risk of future ASCVD events. The ∆10-year ASCVD risk/year can be used as an indicator of primary prevention and guide the application of preventive measures.
当代心血管一级预防基于评估发生动脉粥样硬化性心血管疾病（ASCVD）的 10 年风险。然而，10 年 ASCVD 风险估计值（∆10 年 ASCVD 风险/年）的时间变化的临床意义尚不清楚。
从韩国国家健康保险服务数据中选择了 211077 名没有确诊 ASCVD 且重复进行 4 至 5 年间隔的 10 年 ASCVD 风险评估的参与者。主要终点是心肌梗死、卒中和冠状动脉血运重建以及全因死亡的复合事件。
无论基线 10 年 ASCVD 风险如何，ASCVD 事件发生率均与 ∆10 年 ASCVD 风险/年成正比。每增加 1% ∆10 年 ASCVD 风险/年，ASCVD 事件的调整后风险比为 1.53（95%CI，1.44-1.63）、1.24（95%CI，1.15-1.32）、1.18（95%CI，1.13-1.23）和 1.05（95%CI，1.00-1.10），基线 10 年 ASCVD 风险<5%、5%至 7.5%、7.5%至 20%和≥20%的参与者。包括低密度脂蛋白胆固醇、血压、体重指数、运动习惯和吸烟状况在内的危险因素的适当控制与较低的 ASCVD 事件发生率相关，而未能控制这些危险因素则导致更高的 ASCVD 事件发生率。
在 4 至 5 年期间，10 年 ASCVD 风险的时间变化反映了控制主要心血管危险因素的成功或失败情况，并预示着未来发生 ASCVD 事件的风险。∆10 年 ASCVD 风险/年可作为一级预防的指标，并指导预防措施的应用。
