Siniawski Daniel, Masson Gerardo, Masson Walter, Barbagelata Leandro, Destaville Josefina, Lynch Santiago, Vitagliano Laura, Parodi Josefina Belén, Berton Felipe, Indavere Agustin, Epstein Teo, Huerin Melina
Consejo de Epidemiología y Prevención Cardiovascular, Sociedad Argentina de Cardiología, Buenos Aires, Argentina.
Servicio de Cardiología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Int J Cardiol Cardiovasc Risk Prev. 2023 Jul 21;18:200198. doi: 10.1016/j.ijcrp.2023.200198. eCollection 2023 Sep.
Residual risk management in patients with previous cardiovascular disease (CVD) is a relevant issue. Objectives: 1) to assess the residual risk of patients with CVD using the new scores developed to predict recurrent CVD events (SMART score/SMART-REACH model); 2) to determine the use of therapies with cardiovascular benefit and the achievement of therapeutic goals in patients with very high residual risk.
A multicenter, descriptive, cross-sectional study was performed. Individuals over 18 years of age with CVD were included consecutively. The 10-year risk of recurrent events was estimated using the SMART score and the SMART-REACH model. A value ≥ 30% was considered "very high risk".
In total, 296 patients (mean age 68.2 ± 9.4 years, 75.7% men) were included. Globally, 32.43% and 64.53% of the population was classified as very high risk by the SMART score and the SMART-REACH model, respectively. Among patients classified as very high risk by the SMART score, 45.7% and 33.3% were treated with high-intensity statins and reached the goal of LDL-C <55 mg/dL, respectively. The results were similar when evaluating very high patients according to the SMART-REACH model (high-intensity statins: 59.7%; LDL-C <55 mg/dL: 43.9%). Few very high-risk patients with diabetes were receiving glucose-lowering drugs with demonstrated cardiovascular benefit.
In this secondary prevention population, the residual risk was considerable. Underutilization of standard care treatments and failure to achieve therapeutic goals were evident even in subjects with very high residual risk.
既往有心血管疾病（CVD）患者的残余风险管理是一个重要问题。目标：1）使用新开发的用于预测复发性CVD事件的评分（SMART评分/SMART-REACH模型）评估CVD患者的残余风险；2）确定在残余风险非常高的患者中使用具有心血管益处的治疗方法以及实现治疗目标的情况。
进行了一项多中心、描述性横断面研究。连续纳入18岁以上的CVD患者。使用SMART评分和SMART-REACH模型估计复发性事件的10年风险。值≥30%被认为是“非常高风险”。
共纳入296例患者（平均年龄68.2±9.4岁，75.7%为男性）。总体而言，分别有32.43%和64.53%的人群被SMART评分和SMART-REACH模型分类为非常高风险。在被SMART评分分类为非常高风险的患者中，分别有45.7%和33.3%接受了高强度他汀类药物治疗并达到了LDL-C<55mg/dL的目标。根据SMART-REACH模型评估非常高风险患者时结果相似（高强度他汀类药物：59.7%；LDL-C<55mg/dL：43.9%）。很少有糖尿病的非常高风险患者接受了具有已证实心血管益处的降糖药物治疗。
在这个二级预防人群中，残余风险相当大。即使在残余风险非常高的受试者中，标准护理治疗的利用不足和治疗目标未实现也很明显。
