背景:采用多种胆固醇指南,我们通过2004年NCEP/ATPIII评估了推荐的他汀类药物治疗对确定冠状动脉钙(CAC)和心血管疾病(CVD)事件的准确性,2016ESC/EAS,和2013年ACC/AHA指南。
目的:ACC/AHA指南更准确地识别有心血管疾病风险的人。
方法:5002/6814名年龄<75岁且无心血管疾病的参与者纳入研究。考虑了CAC类别(>0,≥100和≥300)和10年的CVD结局。灵敏度(SN),特异性(SP),阳性和阴性预测值(PPV和NPV),并计算似然比(LR)。平均年龄为59岁;47%的受试者是男性。
结果:1297(26%),1381(28%),和2538(51%)有I类适应症他汀类药物/LLT由NCEPATPIII,ESC/EAS,和AHA/ACC指南,分别。SN,SP,NPV,CAC≥300的PPV为:NCEPATPIII(41.1%,75.5%,93.3%和13.4%),ESC/EAS(54.1%,74.8%,94.6%和16.6%),和ACC/AHA(87.2%,52.6%,97.8%和14.5%)。SN,SP,PPV,相应CVD结局的NPV为:NCEPATPIII(45.8%,75.1%,96.3%,和8.9%),ESC/EAS(50.5%,72.9%,98.7%,和3.6%),和AHA/ACC(79.6%,50.7%,98%,和7.7%)。ESC/EAS的阳性LR2.15(95%CI,1.95-2.38)明显较高,ACC/AHA的阴性LR明显较低[0.24,(95%CI0.19-0.31)]。
结论:尽管ACC/AHA增加了他汀类药物资格的SN,CAC/未来CVD事件的NPV和PPV相似。他汀类药物的ACC/AHAI类适应症可能是亚临床和临床CVD的优越筛查工具。
BACKGROUND: With multiple cholesterol guidelines, we evaluated the accuracy of recommended statin therapy on identifying coronary artery calcium (CAC) and cardiovascular disease (CVD) events by 2004 NCEP/ ATP III, 2016 ESC/EAS, and 2013 ACC/AHA guidelines.
OBJECTIVE: ACC/AHA guidelines are more accurate in identifying persons at risk for CVD.
METHODS: 5002/6814 participants age <75 years and free of CVD were included. CAC categories (>0, ≥100, and ≥300) and 10 years of CVD outcomes were considered. Sensitivity (SN), specificity (SP), positive and negative predictive value (PPV and NPV), and likelihood ratios (LR) were calculated. Mean age was 59 years; 47% of subjects were males.
RESULTS: 1297 (26%), 1381 (28%), and 2538 (51%) had class I indications for statin/LLT by the NCEP ATP III, ESC/EAS, and AHA/ACC guidelines, respectively. SN, SP, NPV, and PPV for CAC ≥300 were: NCEP ATP III (41.1%, 75.5%, 93.3% and 13.4%), ESC/EAS (54.1%, 74.8%, 94.6% and16.6%), and ACC/AHA (87.2%, 52.6%, 97.8% and 14.5%). SN, SP, PPV, and NPV for corresponding CVD outcomes were: NCEP ATP III (45.8%, 75.1%, 96.3%, and 8.9%), ESC/EAS (50.5%, 72.9%, 98.7%, and 3.6%), and AHA/ACC (79.6%, 50.7%, 98%, and 7.7%). ESC/EAS had significantly higher positive LR 2.15 (95% CI, 1.95 - 2.38) and ACC/AHA had significantly lower negative LR [0.24, (95% CI 0.19 - 0.31)] for corresponding CVD.
CONCLUSIONS: Despite the increased in SN of statin eligibility by the ACC/AHA, it has similar NPV and PPV for CAC/future CVD events. The ACC/AHA class I indications for statin may be a superior screening tool for subclinical and clinical CVD.