Komnianou Aikaterini, Kyriakoulis Konstantinos G, Menti Ariadni, Dimakakos Evangelos, Stergiou George S, Kollias Anastasios
Hypertension Center STRIDE-7, School of Medicine, National and Kapodistrian University of Athens, Third Department of Medicine, Sotiria Hospital, 152 Mesogion Avenue, Athens 11527, Greece.
J Clin Med. 2025 Mar 25;14(7):2220. doi: 10.3390/jcm14072220.
Cardiovascular disease remains the leading cause of morbidity and mortality worldwide, underscoring the importance of effective primary prevention strategies. Current total cardiovascular disease (CVD) risk assessment tools, such as the Systematic Coronary Risk Evaluation 2 (SCORE2) in Europe and the Pooled cohort equations (PCEs) and Predicting Risk of CVD EVENTs (PREVENT) in the USA, aim to identify individuals at high CVD risk and guide clinical decision-making in the primary prevention setting. Statin therapy reduces cardiovascular events and is recommended as the first step for individuals with estimated CVD risk above specific thresholds. Moreover, the presence of risk modifiers, as well as the detection of asymptomatic atherosclerosis, reclassifies low-moderate CVD risk individuals into higher risk categories, contributing to tailored therapeutic decisions in primary prevention. However, differences in the performance of the available CVD risk assessment tools, the recommended thresholds for intervention, and the treatment targets by scientific societies introduce considerable inconsistency to the statin therapy practices. In addition, physicians' inertia and poor patients' adherence contribute to inadequate dyslipidemia control rates. This narrative review examines the available evidence on the current most used CVD risk assessment tools and the respective lipid-lowering recommendations, and highlights the role of targeted screening for asymptomatic atherosclerosis in terms of individualized therapy for primary prevention.
心血管疾病仍然是全球发病和死亡的主要原因，这凸显了有效一级预防策略的重要性。当前的总心血管疾病（CVD）风险评估工具，如欧洲的系统性冠状动脉风险评估2（SCORE2）、美国的合并队列方程（PCEs）和预测心血管疾病事件风险（PREVENT），旨在识别心血管疾病高风险个体，并在一级预防环境中指导临床决策。他汀类药物治疗可减少心血管事件，被推荐作为估计心血管疾病风险高于特定阈值的个体的第一步治疗。此外，风险修正因素的存在以及无症状动脉粥样硬化的检测，会将低至中度心血管疾病风险个体重新分类为高风险类别，有助于在一级预防中做出个性化治疗决策。然而，现有心血管疾病风险评估工具的性能差异、推荐的干预阈值以及各科学学会的治疗目标，给他汀类药物治疗实践带来了相当大的不一致性。此外，医生的惰性和患者依从性差导致血脂异常控制率不足。这篇叙述性综述审视了关于当前最常用的心血管疾病风险评估工具以及相应降脂建议的现有证据，并强调了针对无症状动脉粥样硬化进行靶向筛查在一级预防个体化治疗方面的作用。
