目的:对明显健康的个体使用全身冠状动脉风险评估2(SCORE2)时,评估符合降脂治疗(LLT)的比例。
方法:随机邀请50-64岁的人参加瑞典心肺生物图像研究(SCAPIS,n=30,154)。既往有动脉粥样硬化性心血管疾病(CVD)的参与者,糖尿病,或排除慢性肾病.使用SCORE2方程和多单元图估计CVD的10年风险。根据2021年欧洲心脏病学会CVD预防指南估计LLT的资格。使用冠状动脉计算机断层扫描血管造影(CCTA)确定冠状动脉粥样硬化的存在。
结果:在26,570名明显健康的个体中,32%有高,4%的人有很高的10年心血管疾病风险,根据SCORE2方程。在高风险和极高风险人群中,99%的人LDL-C水平高于指导目标,占总人口的35%符合LLT的条件。在那些符合条件的人中,正在进行成像,根据CCTA,38%的人没有冠状动脉粥样硬化的迹象。使用SCORE2图表,52%的人口有资格获得LLT,其中44%没有冠状动脉粥样硬化的迹象。在那些高风险或非常高风险的人中,正在进行的LLT报告有7%,另有11%在参与研究后6个月内接受了LLT.
结论:几乎所有具有高和极高CVD风险的明显健康个体,占总人口的35%,根据准则有资格获得LLT,大部分没有动脉粥样硬化的迹象。与SCORE2方程相比,SCORE2图表导致更多的人有资格获得LLT。
■根据2021年ESC指南,使用SCORE2时,有多少比例的看似健康的中年人符合降脂治疗(LLT)的条件?根据冠状动脉成像,有多少比例的符合LLT的患者有动脉粥样硬化?
结果:根据指南,根据SCORE2方程,几乎所有被归类为高风险和极高风险的个体,占总人口的35%,有资格获得LLT,其中38%没有冠状动脉粥样硬化的迹象。当使用SCORE2多单元图时,这些比例增加。
结论:实施SCORE2和ESC指南将导致三分之一以上的明显健康的中年人符合LLT的资格。很大一部分没有冠状动脉粥样硬化的迹象。
OBJECTIVE: To estimate the proportion eligible for lipid-lowering therapy (LLT) when using the systemic coronary risk estimation 2 (SCORE2) on apparently healthy individuals.
METHODS: Individuals aged 50-64 years were randomly invited to the Swedish cardiopulmonary bioimage study (SCAPIS, n=30,154). Participants with previous atherosclerotic cardiovascular disease (CVD), diabetes mellitus, or chronic kidney disease were excluded. The 10-year risk of CVD was estimated using the SCORE2 equation and the multicell chart. Eligibility for LLT was estimated according to the 2021 European Society of Cardiology CVD prevention
guidelines. Presence of coronary atherosclerosis was determined using coronary computed tomography angiography (CCTA).
RESULTS: Among 26,570 apparently healthy individuals, 32% had high, and 4% had very-high 10-year CVD risk, according to the SCORE2 equation. Among high and very-high risk individuals, 99% had LDL-C levels above
guideline goals making 35% of the total population eligible for LLT. Of those eligible, undergoing imaging, 38% had no signs of coronary atherosclerosis according to CCTA. Using the SCORE2 chart, 52% of the population were eligible for LLT, of which 44% had no signs of coronary atherosclerosis. In those with high or very-high risk, ongoing LLT was reported in 7% and another 11% received LLT within six months after study participation.
CONCLUSIONS: Nearly all apparently healthy individuals with high and very-high CVD risk, or 35% of the total population, were eligible for LLT according to guidelines, and a large proportion had no signs of atherosclerosis. Compared with the SCORE2 equation, the SCORE2 chart resulted in more individuals being eligible for LLT.
UNASSIGNED: What proportion of an apparently healthy middle-aged population would be eligible for lipid-lowering therapy (LLT) according to the 2021 ESC
guidelines when using SCORE2? What proportion of those eligible for LLT have atherosclerosis according to coronary imaging?
RESULTS: According to the
guidelines, nearly all individuals categorized as high and very-high risk according to the SCORE2 equation, or 35% of the total population, were eligible for LLT, of which 38% had no signs of coronary atherosclerosis. These proportions increased when the SCORE2 multicell chart was used.
CONCLUSIONS: Implementing SCORE2 and the ESC
guidelines would result in more than one in three apparently healthy middle-aged individuals being eligible for LLT. A significant proportion would have no signs of coronary atherosclerosis.