世界卫生组织/国际高血压学会绝对心血管风险预测评分在加纳近期卒中幸存者中的意义——来自PINGS2多中心研究的见解
The Significance of the WHO/ISH Absolute Cardiovascular Risk Prediction Scores among Recent Stroke Survivors in Ghana-Insights from the PINGS2 multicenter study.
作者信息
Bockarie Ansumana S, Ayisi-Boateng Nana Kwame, Nguah Samuel Blay, Appiah Lambert Tetteh, Fiattor Timothy, Afriyie-Ansah Sanaa, MacCready Evans, Sam Victoria Aba, Mensah Nathaniel Adusei, Tagge Raelle, Agyenim-Boateng Kwadwo Gyebi, Ampofo Micheal, Laryea Ruth, Gyamfi Rexford Adu, Amuasi J H, Arthur Agnes Amankwaah, Duah Christiana, Opare-Addo Priscilla Abrafi, Ovbiagele Bruce, Sarfo Fred Stephen, Akpalu Albert
机构信息
University of Cape Coast.
University of Science & Technology Hospital.
出版信息
Res Sq. 2025 Mar 12:rs.3.rs-6175913. doi: 10.21203/rs.3.rs-6175913/v1.
BACKGROUND
The leading cause of stroke remains atherosclerotic cardiovascular disease. The World Health Organization/International Society of Hypertension risk score represents an effort to produce a risk assessment tool for atherosclerotic cardiovascular disease that is regionally specific. No previous work has described absolute cardiovascular risk scores among recent stroke survivors in West Africa via this tool.
METHODS
A cross-sectional analysis of baseline data from the multicenter, phase III randomized, open-label, clinical trial, Phone-based Intervention under Nurse Guidance II (PINGS-2), was performed. Data from 414 participants who had recently survived a stroke and met the age range compatible with the risk estimation tool were analyzed. The WHO/ISH score was calculated for each participant and categorized into low, moderate, and high/very high CVD risk scores. Demographic data, medical histories, anthropometry, vascular risk profiles, stroke types and severity indices were compared across CVD risk categories. Multivariate logistic regression was performed to further examine variables significantly associated with WHO/ISH CVD risk via univariate analysis.
RESULTS
The mean age of the study population was 58 years (SD = 12), with the majority being male (56.5%). Ischemic strokes (n = 263, 74.3%) were more common than hemorrhagic strokes (n = 78, 22%). Over two-thirds (76.3%) of the participants were estimated to have a low (< 10%) risk of cardiovascular disease in the next 10 years, 14.5% were estimated to have a moderate risk, and only 9.2% were stratified as high or very high risk. The absolute CVD risk score was significantly associated with age, higher income, tobacco use, systolic blood pressure and HBA1c. There was no significant difference in absolute cardiovascular risk by stroke type.
CONCLUSION
A comparatively lower proportion of Ghanaian stroke survivors were classified as high risk by the WHO/ISH risk score. This raises the question of its appropriateness as a cardiovascular risk assessment tool to drive secondary prevention among this patient population.
TRIAL REGISTRATION
NCT04404166. Registered on May 27,2020 at ClinicalTrials.gov.
背景
中风的主要原因仍然是动脉粥样硬化性心血管疾病。世界卫生组织/国际高血压学会风险评分旨在开发一种针对动脉粥样硬化性心血管疾病的区域特异性风险评估工具。此前尚无研究通过该工具描述西非近期中风幸存者的绝对心血管风险评分。
方法
对多中心、III期随机、开放标签临床试验“护士指导下的电话干预II（PINGS-2）”的基线数据进行横断面分析。分析了414名近期中风幸存且年龄范围符合风险评估工具要求的参与者的数据。计算每位参与者的WHO/ISH评分，并将其分为低、中、高/极高心血管疾病风险评分。比较不同心血管疾病风险类别的人口统计学数据、病史、人体测量学、血管风险概况、中风类型和严重程度指数。进行多变量逻辑回归分析，以通过单变量分析进一步检验与WHO/ISH心血管疾病风险显著相关的变量。
结果
研究人群的平均年龄为58岁（标准差=12），大多数为男性（56.5%）。缺血性中风（n = 263，74.3%）比出血性中风（n = 78，22%）更常见。超过三分之二（76.3%）的参与者预计在未来10年中心血管疾病风险较低（<10%），14.5%预计有中度风险，只有9.2%被分层为高或极高风险。绝对心血管疾病风险评分与年龄、较高收入、吸烟、收缩压和糖化血红蛋白显著相关。不同中风类型的绝对心血管疾病风险无显著差异。
结论
根据WHO/ISH风险评分，加纳中风幸存者中被归类为高风险的比例相对较低。这引发了一个问题，即该评分作为心血管风险评估工具来推动该患者群体二级预防的适用性。
试验注册
NCT04404166。于2020年5月27日在ClinicalTrials.gov注册。
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