孙照阳,张巧,徐淑静,彭年春,胡颖,张淼,时立新
SUN Zhaoyang,ZHANG Qiao,XU Shujing,PENG Nianchun,HU Ying,ZHANG Miao,SHI Lixin

• 1:贵州医科大学附院内分泌代谢病科

摘要(Abstract)：

目的:探讨两种方法预测贵阳地区40岁以上人群未来10年患心血管病发病风险的可行性。方法:收集贵阳地区4 122名居民2011年的基线资料,采用动脉粥样硬化性心血管疾病风险预测模型(China-PAR模型)和2013美国心脏病学院/美国心脏协会推荐的汇总队列公式模型(PCE)预测该人群未来10年患心血管疾病发病风险及风险等级,比较两种方法预测结果的一致性及推荐使用他汀类药物人群所占比例。结果:ChinaPAR模型显示,该人群未来10年心血管病发病风险为1.83%、低危的比例为87.7%、高危的比例为12.3%、PCE模型显示,该人群未来10年心血管病发病风险为7.20%、低危的比例为65.7%、高危的比例34.3%;两种方法预测结果比较,差异有统计学意义(P<0.05),一致性检验Kappa值为0.022;China-PAR模型及PCE模型预测使用他汀类药物的比例分别为43.3%及53.6%。结论:China-PAR模型预测未来10年心血管病发病风险高危的比例低于用美国PCE模型,两种方法预测结果一致性较差,China-PAR模型较PCE模型建议更少的人群使用他汀类药物。
Objective: To investigate the difference of cardiovascular assessment methods in evaluation of 10-year cardiovascular risks in people over 40 years old. Methods: A total of 10 140 adults aged 40 and over were selected from Guiyang urban districts based cross-sectional study. Data were obtained from questionnaire surveys,physical and biochemical examinations were evaluated by Prediction for ASCVD Risk in China( China-PAR),Pooled cohort equations( PCE) reported in the American College of Cardiology/American Heart Association( ACC/AHA). Results: China-PAR model showed that the proportion of low risk was 87. 7%,and the proportion of high risk was 12. 3%. PCE model showed that the proportion of low risk was 65. 7,and the proportion of high risk was 34. 3. The difference between the two methods was statistically significant( P < 0. 05),Kappa = 0. 022. According to the guideline for the prevention and treatment of lipids,the two methods showed that the proportion of both China-PAR and PCE models to use statins were 43. 3% and 53. 6% respectively. Conclusion:The incidence proportion of 10-year cardiovascular risk predicted by China-PAR model is lower than the proportion predicted by PCE model. The results of the two methods are not consistent with each other. China-PAR model suggests fewer individuals use statins than the PCE model does.

关键词(KeyWords)： 心血管疾病;预测;China-PAR模型;PCE模型;他汀类药物
cardiovascular diseases;predict;China-PAR model;PCE model;statins

Abstract:

Keywords:

基金项目(Foundation): 上海交通大学医学院附属瑞金医院项目(201502007);; 贵州省省长资金临床应用课题专项研究项目[黔省专合字(2012)100号];; 贵州省临床重点专科培育项目

作者(Author): 孙照阳,张巧,徐淑静,彭年春,胡颖,张淼,时立新
SUN Zhaoyang,ZHANG Qiao,XU Shujing,PENG Nianchun,HU Ying,ZHANG Miao,SHI Lixin

DOI: 10.19367/j.cnki.1000-2707.2018.07.017

参考文献(References)：

• [1]国家心血管病中心.中国心血管病报告2016[M].北京:中国大百科全书出版社,2017.
• [2]YANG X,LI J,HU D,et al.Predicting the 10-year risks of atherosclerotic cardiovascular disease in Chinese population:The China-PAR project(prediction for ASCVD risk in China)[J].Circulation,2016,134(19):1430-1440.
• [3]GOFF J R,LLOYD-JONES D M,BENNETT G,et al.2013 ACC/AHA guideline on the assessment of cardiovascular risk:A report of the American college of cardiology/American heart association task force on practice guidelines[J].J AM Coll Cardiol,63(2014):2935-2959.
• [4]中国成人血脂异常防治指南修订联合委员会.中国成人血脂异常防治指南(2016年修订版)[J].中华心血管病杂志,2016,44(10):833-853.
• [5]PERK J,DE BACKER G,GOHLKE H,et al.European guidelines on the cardiovascular disease prevention in clinical practice(version 2012).The fifth joint task force of the European society of cardiology and other societies on Cardiovascular disease prevention in clinical practice(constituted by representatives of nine societies and by invited experts)[J].Eur Heart J,33(2012):1635-1701.
• [6]RIDKER P M,COOK N R.Statins:New American guidelines for prevention of cardiovascular disease[J].Lancet,2013,382(9907):1762-1765.
• [7]FILION K B,LUEPKER R V.Cigarette smoking and cardiovascular disease:Lessons from Framingham[J].Global Heart,2013(8):35-41.
• [8]LEWIS W R,ELLRODT A G,PETERSON E,et al.Trends in the use of evidence-based treatment for coronary artery disease among women and the elderly:Finding from the get with the guidelines quality-improvement program[J].Circ Cardiovasc Qual Outcomes,2015(2):633-641.
• [9]MENDELSOHN M E,KARAS R H.The protective effects of estrogen on the cardiovascular system[J].N Eng J Med,1999(340):1801-1811.
• [10]KOPECKYSTEPHEN L,NEHRAJAY A.Cardiovascular risk and cholesterol management in men:Implications of the new guidelines[J].Journal of Men's Health,2014,11(2):51-52.
• [11]王薇,赵冬,刘静,等.中国35~64岁人群心血管病危险因素与发病危险预测模型的前瞻性研究[J].中华心血管病杂志,2003,31(12):902-908.
• [12]李慧凤,王萍,王鸿雁,等.“国人缺血性心血管病十年发病危险评估方法”在青岛地区的临床应用及分析[J].中华心血管病杂志,2005,33(2):178-180.
• [13]孙喜琢,王雪,潘晓芳,等.大连市獐子岛地区心血管疾病危险因素的流行病学调查[J].中国心血管杂志,2008,13(4):82-85.
• [14]赵钢.脑卒中防治与血压管理[J].中华高血压杂志,2013,21(2):112-115.
• [15]贾贡献,余金明,林凡礼,等.高血压患者吸烟状况与心血管危险分层的关系[J].中华高血压杂志,2013,21(4):340-345.
• [16]曹尉尉,吴杲,蒋红,等,某院住院患者他汀类药物使用情况调查与分析[J].海军医学杂志,2014,7(35):256-259.
• [17]仝其广,胡大一,王锦文,等,冠心病二级预防药物长期治疗状况调查[J].中国医药导刊,2007,9(3):194-195.
• [18]KAVOUSI M,LEENING M J,NABCHEN D,et al.Comparison of application of the ACC/AHA guidelines,adult treatment panel III guidelines,and European society of cardiology guidelines for cardiovascular disease prevention in a European cohort[J].JAMA,2014(311):1416-1423.
• [19]RIDKER P M,COOK N R.Statins:New American guidelines for prevention of cardiovascular disease[J].Lancet,2013,382(9907):1762-1765.
• [20]SILVERMAN M G,FERENCE B A,IM K,et al.Association between lowering LDL-C and cardiovascular risk reduction among different therapeutic interventions:a systematic review and meta-analysis[J].JAMA,2016,316(12):1289-1297.

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