Jersey Shore University Medical Center, Department of Medicine, 1945 NJ-33, Neptune City, NJ, 07753, USA.
Jersey Shore University Medical Center, Department of Cardiology, 1945 NJ-33, Neptune City, NJ, 07753, USA.
Atherosclerosis. 2024 Dec;399:118626. doi: 10.1016/j.atherosclerosis.2024.118626. Epub 2024 Oct 10.
Effective hypercholesterolemia management is linked to lower all-cause and cardiovascular mortality. The 2018 AHA/ACC guidelines recommended using the Pooled Cohort Equations (PCE) for lipid management, but these may overestimate risk and be less accurate for certain racial groups. The AHA's new PREVENT equation, which omits race and includes cardiometabolic factors, aims to provide a more accurate risk assessment for a diverse population. However, it has not yet been applied to a nationally representative US population, and implementation guidelines are still lacking. Our study aimed to evaluate potential changes in hypercholesterolemia management for primary prevention by using the PREVENT equation instead of the PCE.
Analyzing pre-pandemic NHANES 2017-2020 data, participants aged 40-75 without prior lipid-lowering treatment or other compelling indication were identified for elevated risk (≥7.5 %) using the PCE and PREVENT equations. We assessed risk shifts and indications for statin therapy, comparing the two risk equations. NHANES guidelines with weighting were followed to obtain US nationally representative estimates.
Out of 77, 647, 807 (unweighted = 2494) participants, 81.0 % had no change in risk. The PCE flagged 18.8 % (n = 14,614,094) of participants at elevated risk not identified by PREVENT, while 0.20 % (n = 107,813) were flagged only by PREVENT. Participants identified solely by the PCE were older, with higher systolic blood pressure and increased estimated glomerular filtration rates. Indications for statin therapy were largely unchanged (81.0 %). PREVENT newly identified (0.20 %) for moderate-intensity therapy and none for high-intensity therapy. Participants qualifying for moderate intensity therapy by the PCE were reclassified to no therapy in 74.59 % of cases, while 25.41 % remained unchanged. Participants qualifying for high-intensity therapy by the PCE were reclassified to moderate therapy in 93.97 % of cases, and 6.03 % were reclassified to no therapy.
The PREVENT equation notably differs in identifying hypercholesterolemia candidates compared to the PCE. Its adoption would influence cardiovascular risk reduction therapy recommendations, emphasizing the need for comprehensive studies to understand its long-term impact and reevaluate the threshold of treatment strategies for improved patient outcomes.
有效的高胆固醇血症管理与较低的全因和心血管死亡率相关。2018 年 AHA/ACC 指南建议使用汇总队列方程（PCE）进行血脂管理，但这些方程可能会高估风险，并且对某些种族群体的准确性较低。AHA 的新 PREVENT 方程省略了种族因素，并包含了代谢因素，旨在为不同人群提供更准确的风险评估。然而，它尚未应用于具有代表性的美国全国人群，并且实施指南仍然缺乏。我们的研究旨在评估使用 PREVENT 方程代替 PCE 对原发性预防的高胆固醇血症管理可能产生的变化。
我们分析了 2017-2020 年 NHANES 预疫情数据，使用 PCE 和 PREVENT 方程确定无降脂治疗或其他强烈适应证且年龄在 40-75 岁之间的人群中风险升高（≥7.5%）。我们评估了两种风险方程下的风险转移和他汀类药物治疗指征。我们遵循 NHANES 指南并进行加权处理，以获得美国全国代表性的估计值。
在 77647807 名（未加权=2494）参与者中，81.0%的人风险没有变化。PCE 标记出 18.8%（n=14614094）的参与者处于 PREVENT 未识别的升高风险状态，而 0.20%（n=107813）的参与者仅被 PREVENT 标记。仅被 PCE 标记的参与者年龄更大，收缩压更高，估算肾小球滤过率增加。他汀类药物治疗的指征基本不变（81.0%）。PREVENT 新识别出（0.20%）中等强度治疗，无高强度治疗。根据 PCE 确定需要中等强度治疗的参与者，74.59%的病例被重新分类为无需治疗，25.41%的病例保持不变。根据 PCE 确定需要高强度治疗的参与者，93.97%的病例被重新分类为中等强度治疗，6.03%的病例被重新分类为无需治疗。
与 PCE 相比，PREVENT 方程在识别高胆固醇血症候选者方面存在显著差异。采用该方程将影响心血管风险降低治疗的推荐，强调需要进行全面研究，以了解其长期影响，并重新评估治疗策略的阈值，以改善患者的治疗效果。
