在英国生物银行中,使用心血管疾病事件预测风险与合并队列方程时他汀类药物适用情况的差异。
Differences in Statin Eligibility With the Use of Predicting Risk of Cardiovascular Disease EVENTs Versus Pooled Cohort Equations in the UK Biobank.
作者信息
Dhaliwal Jasninder S, Gaonkar Mokshad, Patel Nirav, Shetty Naman S, Li Peng, Vekariya Nehal, Kalra Rajat, Arora Garima, Arora Pankaj
机构信息
Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
出版信息
Am J Cardiol. 2025 Apr 15;241:43-51. doi: 10.1016/j.amjcard.2024.12.034. Epub 2025 Jan 3.
The Pooled Cohort Equations (PCEs), developed by the American Heart Association (AHA) and American College of Cardiology, have been widely used since 2013 to estimate 10-year atherosclerotic cardiovascular disease (ASCVD) risk and guide statin therapy. Recently, the AHA introduced the Predicting Risk of CVD EVENTs (PREVENT) equations to improve ASCVD risk estimation. However, the effect of using PREVENT instead of PCEs on risk classification and statin eligibility remains unclear. This retrospective cohort study analyzed 261,303 UK Biobank participants, aged 40 to 69 years, who were free from cardiovascular disease and not on statin therapy. The PCEs and the base PREVENT equations were used to estimate 10-year ASCVD risk, categorize risk levels, and determine statin eligibility based on a common risk threshold of 7.5%. The median 10-year ASCVD risk was 5.2% (2.2%, 10.6%) using the PCEs and 3.5% (1.8%, 5.8%) with the PREVENT equations. The PREVENT equations classified 14.0% of participants as high-risk (ASCVD risk >7.5%), compared to 36.9% classified by PCEs. Among participants classified as intermediate-risk by PCEs, 75.3% were reclassified as low-risk by PREVENT. The proportion of individuals eligible for statin use by the PREVENT equation was 19.9%, and by the PCEs was 40.7%. The corresponding difference was 20.8% (95% confidence intervals [CI]: 20.6% to 20.9%). More men (33.0% [95% CI: 32.7% to 33.3%]) than women (11.5% [95% CI: 11.3% to 11.7%]) and more individuals in the older age group (60 to 69 years: 34.0% [95% CI: 33.7% to34.3%]) than in the younger age group (40 to 49 years: 3.5% [95% CI: 3.3% to 3.6%]) would not be recommended for statin consideration with the PREVENT equations. In conclusion, based on the common risk threshold of 7.5%, replacing the PCEs with the base PREVENT equation would reduce statin eligibility in the UK Biobank participants by ∼20%, especially among men and older adults.
由美国心脏协会(AHA)和美国心脏病学会开发的合并队列方程(PCEs)自2013年以来被广泛用于估计10年动脉粥样硬化性心血管疾病(ASCVD)风险并指导他汀类药物治疗。最近,AHA引入了预测心血管疾病事件风险(PREVENT)方程以改善ASCVD风险估计。然而,使用PREVENT而非PCEs对方程风险分类和他汀类药物适用资格的影响仍不明确。这项回顾性队列研究分析了英国生物银行中261303名年龄在40至69岁之间、无心血管疾病且未接受他汀类药物治疗的参与者。使用PCEs和基础PREVENT方程来估计10年ASCVD风险、对风险水平进行分类,并根据7.5%的通用风险阈值确定他汀类药物适用资格。使用PCEs时,10年ASCVD风险中位数为5.2%(2.2%,10.6%),使用PREVENT方程时为3.5%(1.8%,5.8%)。PREVENT方程将14.0%的参与者分类为高危(ASCVD风险>7.5%),而PCEs分类的比例为36.9%。在被PCEs分类为中危的参与者中,75.3%被PREVENT重新分类为低危。根据PREVENT方程符合使用他汀类药物条件的个体比例为19.9%,PCEs为40.7%。相应差异为20.8%(95%置信区间[CI]:20.6%至20.9%)。与女性(11.5%[95%CI:11.3%至11.7%])相比,更多男性(33.0%[95%CI:32.7%至33.3%])以及年龄较大组(60至69岁:34.0%[95%CI:33.7%至34.3%])的个体相比于较年轻组(40至49岁:3.5%[95%CI:3.3%至
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