Ma Zhiyuan, Moran Lynn N, Shirani Jamshid
Department of Cardiology, St Luke's University Health Network, Bethlehem, USA.
Cureus. 2024 Nov 1;16(11):e72856. doi: 10.7759/cureus.72856. eCollection 2024 Nov.
Primary prevention statin therapy is initiated based on the 10-year ASCVD risk estimated by the pooled cohort equations (PCEs), with treatment effectiveness monitored through low-density lipoprotein cholesterol levels. It remains uncertain whether ASCVD risk accurately predicts the mortality impact of lipid-lowering therapy. This study aims to assess the predictive performance of the PCE for mortality with and without lipid-lowering therapy and the mortality impact of lipid-lowering therapy with similar ASCVD risk.
A retrospective analysis of the National Health and Nutrition Examination Survey (NHANES) (III and 1999-2008) linked to the National Death Index was conducted with propensity score matching. Cox regression and C statistic were used to determine the association between 10-year ASCVD risk and mortality.
In the matched cohort with 4,802 individuals with similar ASCVD risks, the 10-year risk of ASCVD by PCE was comparable for predicting all-cause mortality at 10 years in the lipid-lowering therapy group (area under the curve (AUC), 0.75; 95% confidence interval (CI) 0.73-0.77) and without lipid-lowering therapy (0.74; 95% CI 0.71-0.77; p = 0.50). Similarly, PCE was comparable for predicting cardiovascular mortality at 10 years in both groups (AUC, 0.75; 95% CI 0.70-0.79 versus 0.77; 95% CI 0.73-0.80; p = 0.47). Lipid-lowering therapy was significantly associated with reduced all-cause mortality (adjusted hazard ratio (HR), 0.70; 95% CI 0.61-0.82; p < 0.01) and cardiovascular mortality (adjusted HR, 0.65; 95% CI, 0.51-0.83; p < 0.01), particularly in those with a 10-year ASCVD risk of 7.5% or higher.
The PCE comparably predicts mortality for both those on and off lipid-lowering therapy. Those on therapy have lower all-cause and cardiovascular mortality despite similar ASCVD risk. This underscores the usefulness of PCE in assessing mortality risk, both before and after treatment.
一级预防他汀类药物治疗是根据汇总队列方程（PCE）估算的10年动脉粥样硬化性心血管疾病（ASCVD）风险启动的，通过低密度脂蛋白胆固醇水平监测治疗效果。ASCVD风险是否能准确预测降脂治疗对死亡率的影响仍不确定。本研究旨在评估PCE对接受和未接受降脂治疗患者死亡率的预测性能，以及相似ASCVD风险下降脂治疗对死亡率的影响。
对与国家死亡指数相关联的国家健康与营养检查调查（NHANES）（III以及1999 - 2008年）进行回顾性分析，并采用倾向评分匹配法。使用Cox回归和C统计量来确定10年ASCVD风险与死亡率之间的关联。
在4802名具有相似ASCVD风险的匹配队列中，PCE估算的10年ASCVD风险在预测降脂治疗组10年全因死亡率（曲线下面积（AUC），0.75；95%置信区间（CI）0.73 - 0.77）和未接受降脂治疗组（0.74；95% CI 0.71 - 0.77；p = 0.50）方面具有可比性。同样，PCE在预测两组10年心血管死亡率方面也具有可比性（AUC，0.75；95% CI 0.70 - 0.79对比0.77；95% CI 0.73 - 0.80；p = 0.47）。降脂治疗与全因死亡率降低显著相关（调整后风险比（HR），0.70；95% CI 0.61 - 0.82；p < 0.01）以及心血管死亡率降低显著相关（调整后HR，0.65；95% CI，0.51 - 0.83；p < 0.01），特别是在10年ASCVD风险为7.5%或更高的人群中。
PCE对接受和未接受降脂治疗的患者死亡率具有相似的预测能力。尽管ASCVD风险相似，但接受治疗的患者全因死亡率和心血管死亡率较低。这突出了PCE在评估治疗前后死亡率风险方面的有用性。
