van Trier Tinka J, Snaterse Marjolein, Dorresteijn Jannick An, Bogaart Manon van den, Scholte Op Reimer Wilma Jm, Visseren Frank Lj, Peters Ron Jg, Jørstad Harald T, Boekholdt S Matthijs
Department of Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
Department of Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands.
Open Heart. 2025 Feb 4;12(1):e002981. doi: 10.1136/openhrt-2024-002981.
Primary prevention strategies for cardiovascular disease (CVD) conventionally rely on 10-year risk estimates of major adverse cardiovascular events (MACE). However, communicating longer-term total CVD risk may better facilitate informed preventive decisions. Therefore, we aimed to quantify how well 10-year observed incidence reflects 20-year observed incidence and how MACE reflects total CVD events across demographic groups, using observations in long-term prospective data.
In individuals aged 40-79 without CVD or diabetes from the population-based EPIC-Norfolk cohort, we compared the first occurrence of 10 and 20 years (1) 3-point MACE events (non-fatal myocardial infarction+non-fatal stroke+fatal CVD) and (2) total CVD events (all non-fatal and fatal CVD events leading to hospitalisation), stratified by sex and age.
Among 22 569 participants (57% women), incident 10-year and 20-year 3-point MACE was 5.3% and 15.5%, respectively, yielding 20/10 year ratios from 2.2 (in older men) to 4.5 (in younger women). Total CVD increased from 10.5% at 10 years to 26.9% at 20 years, with ratios ranging from 1.9 (older men) to 3.9 (younger women). Ratios between 10-year MACE and 20-year total CVD varied substantially, ranging from 3-fold in (older men) to 10-fold (younger women).
The observed incidence of CVD roughly triples from 10 to 20 years of follow-up, with 10-year MACE observations underestimating 20-year total CVD burden by a factor ranging from 3 (older men) to 10 (younger women). These findings highlight the limitations of communicating 10-year MACE risk assessments to facilitate informed decisions in longer-term CVD prevention-particularly in younger women.
心血管疾病（CVD）的一级预防策略传统上依赖于主要不良心血管事件（MACE）的10年风险评估。然而，传达更长期的CVD总风险可能更有助于做出明智的预防决策。因此，我们旨在利用长期前瞻性数据中的观察结果，量化10年观察到的发病率能多好地反映20年观察到的发病率，以及MACE能多好地反映不同人口群体中的CVD总事件。
在基于人群的EPIC-诺福克队列中，对年龄在40 - 79岁且无CVD或糖尿病的个体，我们比较了10年和2（1）3点MACE事件（非致命性心肌梗死+非致命性中风+致命性CVD）和（2）CVD总事件（所有导致住院的非致命性和致命性CVD事件）首次发生的情况，并按性别和年龄进行分层。
在22569名参与者（57%为女性）中，10年和20年3点MACE的发生率分别为5.3%和15.5%，20/10年比率从2.2（老年男性）到4.5（年轻女性）不等。CVD总发生率从10年时的10.5%上升到20年时的26.9%，比率从1.9（老年男性）到3.9（年轻女性）不等。10年MACE与20年CVD总发生率之间的比率差异很大，从（老年男性）的3倍到（年轻女性）的10倍不等。
CVD的观察发病率在随访10年到20年期间大致增加两倍，10年MACE观察结果将20年CVD总负担低估了3倍（老年男性）到10倍（年轻女性）。这些发现凸显了传达10年MACE风险评估以促进长期CVD预防中明智决策的局限性，尤其是在年轻女性中。
