Yu-Chung Hsiao , Thung-Lip Lee , Fang-Ju Lin , Chin-Feng Hsuan , Chih-Fan Yeh , Wei-Tien Chang , Hsien-Li Kao , Jiann-Shing Jeng , Yen-Wen Wu , I-Chang Hsieh , Ching-Chang Fang , Kuo-Yang Wang , Kuan-Cheng Chang , Tsung-Hsien Lin , Wayne Huey-Herng Sheu , Yi-Heng Li , Wei-Hsian Yin , Hung-I Yeh , Jaw-Wen Chen , Chau-Chung Wu
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Two multi-center prospective observational registry cohorts, T-SPARCLE and T-PPARCLE, were used to validate the scoring system, and the primary outcome was the time to first occurrence/recurrence of major adverse cardiac events (MACEs). The MUS model's performance was compared to other models from Europe and Japan.</p></div><div><h3>Results</h3><p>A total of 10,733 patients with the mean age of 64.2 (SD: 11.9) and 36.5% female were followed up for a median of 5.4 years. The MUS model was validated, with an AUC score of 0.73 (95% CI 0.68–0.78). The European and Japanese models had AUC scores ranging from 0.6 to 0.7. The MUS model categorized patients into four distinct CV risk groups, with hazard ratios (HRs) as follows: very high- vs. high-risk group (HR = 1.91, 95% CI 1.53–2.39), high- vs. moderate-risk group (HR = 2.08, 95% CI 1.60–2.69), and moderate- vs. low-risk group (HR = 3.14, 95% CI 1.63–6.03). 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引用次数: 0
摘要
背景:本研究旨在评估改良美国(MUS)模型在预测亚洲患者心血管事件风险方面的性能,并将其与欧洲和日本模型进行比较:本研究旨在评估改良的美国(MUS)模型在预测亚洲患者心血管(CV)事件风险方面的性能,并将其与欧洲和日本的模型进行比较:方法:根据美国 ACC/AHA 2018 年血脂治疗指南,采用 MUS 模型对一级或二级预防患者进行分层。两个多中心前瞻性观察登记队列(T-SPARCLE 和 T-PPARCLE)用于验证该评分系统,主要结果是首次发生/再次发生重大心脏不良事件(MACE)的时间。MUS 模型的性能与欧洲和日本的其他模型进行了比较:共对 10,733 名患者进行了中位数为 5.4 年的随访,这些患者的平均年龄为 64.2 岁(SD:11.9),36.5% 为女性。毛里求斯模型得到了验证,AUC 得分为 0.73(95% CI 0.68-0.78)。欧洲和日本模型的 AUC 得分为 0.6 至 0.7。MUS 模型将患者分为四个不同的 CV 风险组,其危险比(HRs)如下:极高风险组与高风险组(HR = 1.91,95% CI 1.53-2.39)、高风险组与中度风险组(HR = 2.08,95% CI 1.60-2.69)、中度风险组与低风险组(HR = 3.14,95% CI 1.63-6.03)。在对MUS模型进行调整后,动脉粥样硬化性血管疾病(ASCVD)病史不是各风险组不良心血管结局的重要预测因素:MUS模型是对伴有或不伴有ASCVD的亚洲患者进行风险分层的有效工具,它能准确预测MACEs,其表现与其他已建立的风险模型相当或更好。我们的研究结果表明,患者管理的重点应放在背景风险因素上,而不是仅仅关注一级或二级预防。
A risk stratification model modified from the U.S. guideline could be applied in an Asian population with or without ASCVD: Validation study
Background
This study aimed to evaluate the performance of a modified U.S. (MUS) model for risk prediction of cardiovascular (CV) events in Asian patients and compare it to European and Japanese models.
Methods
The MUS model, based on the US ACC/AHA 2018 lipid treatment guideline, was employed to stratify patients under primary or secondary prevention. Two multi-center prospective observational registry cohorts, T-SPARCLE and T-PPARCLE, were used to validate the scoring system, and the primary outcome was the time to first occurrence/recurrence of major adverse cardiac events (MACEs). The MUS model's performance was compared to other models from Europe and Japan.
Results
A total of 10,733 patients with the mean age of 64.2 (SD: 11.9) and 36.5% female were followed up for a median of 5.4 years. The MUS model was validated, with an AUC score of 0.73 (95% CI 0.68–0.78). The European and Japanese models had AUC scores ranging from 0.6 to 0.7. The MUS model categorized patients into four distinct CV risk groups, with hazard ratios (HRs) as follows: very high- vs. high-risk group (HR = 1.91, 95% CI 1.53–2.39), high- vs. moderate-risk group (HR = 2.08, 95% CI 1.60–2.69), and moderate- vs. low-risk group (HR = 3.14, 95% CI 1.63–6.03). After adjusting for the MUS model, a history of atherosclerotic vascular disease (ASCVD) was not a significant predictor of adverse cardiovascular outcomes within each risk group.
Conclusion
The MUS model is an effective tool for risk stratification in Asian patients with and without ASCVD, accurately predicting MACEs and performing comparably or better than other established risk models. Our findings suggest that patient management should focus on background risk factors instead of solely on primary or secondary prevention.
期刊介绍:
Biomedical Journal publishes 6 peer-reviewed issues per year in all fields of clinical and biomedical sciences for an internationally diverse authorship. Unlike most open access journals, which are free to readers but not authors, Biomedical Journal does not charge for subscription, submission, processing or publication of manuscripts, nor for color reproduction of photographs.
Clinical studies, accounts of clinical trials, biomarker studies, and characterization of human pathogens are within the scope of the journal, as well as basic studies in model species such as Escherichia coli, Caenorhabditis elegans, Drosophila melanogaster, and Mus musculus revealing the function of molecules, cells, and tissues relevant for human health. However, articles on other species can be published if they contribute to our understanding of basic mechanisms of biology.
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