Optimize Risk Assessment for Incident and Recurrent Atherosclerotic Cardiovascular Disease

优化事件和复发性动脉粥样硬化性心血管疾病的风险评估

基本信息

批准号：
10667516
负责人：
Jaejin An
金额：
$ 68.42万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-07-15 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10667516
关键词：
Address Adult Algorithms American American Heart Association Asian Asian population Atherosclerosis California Cardiology Cardiovascular system Cholesterol Chronic Kidney Failure Classification Clinical Country Data Data Sources Decision Making Development Discrimination Dose Dyslipidemias East Asian Economics Electronic Health Record Epidemiology Equation Equilibrium Ethnic Origin Ethnic Population European Event Future Goals Guidelines Health Health Insurance Heart failure Hispanic Hispanic Populations Individual Inequity Lipids Literature Mexican Minority Groups National Health and Nutrition Examination Survey Outcome Patients Performance Persons Pharmaceutical Preparations Population Primary Prevention Puerto Rican Race Recommendation Recording of previous events Recurrence Resources Risk Risk Assessment Risk Estimate Risk Factors Risk Reduction Secondary Prevention South Asian Subgroup Treatment Cost Woman cardiovascular disorder risk cardiovascular health cohort college cost effective enhancing factor ethnic diversity ethnic minority ezetimibe health disparity health equity health inequalities high risk improved inhibitor predictive tools racial diversity racial minority risk prediction sex social social health determinants treatment guidelines

项目摘要

Recent American Heart Association (AHA) and American College of Cardiology (ACC) cholesterol guidelines put atherosclerotic cardiovascular disease (ASCVD) risk assessment at the center of decision-making for initiating and dosing of lipid-lowering therapies including statins, ezetimibe, and PCSK9 inhibitors. Nonetheless, there remains controversy regarding how efficiently this guideline directs medication to those who will receive a large absolute ASCVD risk reduction benefit. For primary prevention, the 2018 AHA/ACC guideline introduced the concept of risk-enhancing factors to identify individuals who have a risk higher than predicted by the pooled cohort equations (PCE). The presence of risk-enhancing factors supports a decision to initiate or intensify statin therapy in patients with borderline and intermediate risk. However, the guideline did not quantify how much a risk-enhancing factor changes an individual's 10-year risk, making decisions to treat or not to treat informed by the risk-enhancing factors ultimately subjective. Social determinants of health (SDOH) are important ASCVD risk factors. The PCE systematically underestimates risk for individuals who are socially deprived; however, SDOH are not included in the PCE or considered as risk-enhancing factors in the current guidelines. Additionally, the PCE's performance is questionable in Hispanics and Asians, the two fastest growing minority groups in the US. For secondary prevention, the 2018 guideline recommends high- intensity statin therapy for the 24 million US adults with established ASCVD, with ezetimibe and PCSK9 inhibitors recommended for a subset with a very high risk for recurrent ASCVD, defined by a history of multiple major ASCVD events or one major event with multiple high-risk conditions. However, recent evidence suggests that this definition may classify too many individuals (>50%) as having very high risk. Additionally, women, racial/ethnic minorities, and those with adverse SDOH may have a higher risk for recurrent ASCVD, but those factors were not considered in the current guideline when defining very high risk of recurrent ASCVD. To address these gaps in the literature and guidelines, our study proposes to 1) quantify how much the presence or absence of each risk-enhancing factor (including SDOH and Hispanic and Asian subgroups) and their combinations change 10-year ASCVD risk beyond PCE predictions; 2) determine the algorithm that optimizes the discrimination of individuals at very high risk for a recurrent ASCVD event; and 3) compare the health, economic, and health equity impact among US adults of selecting individuals for lipid-lowering therapies according to approaches identified in Aims 1 and 2 vs. in the 2018 cholesterol guideline. This study will develop approaches that improve the precision of cholesterol treatment guidelines in US adults, and help direct treatment to ethnic subgroups and groups with a high burden of adverse SDOH who have a high ASCVD risk but may not be recommended treatment by current national cholesterol guidelines. Findings from this study will inform future guidelines, improve cardiovascular outcomes, and narrow health inequities.

最近美国心脏协会（AHA）和美国心脏病学院（ACC）胆固醇指南将动脉粥样硬化心血管疾病（ASCVD）的风险评估放在决策中心引发和给药降低脂质的疗法，包括他汀类药物，ezetimibe和PCSK9抑制剂。尽管如此，关于该指南将药物指导到这些指南的有效性仍然存在争议谁将获得大量的绝对ASCVD风险降低益处。对于初级预防，2018 AHA/ACC 指南介绍了增强风险因素的概念，以识别具有高于高于由合并队列方程（PCE）预测。提高风险因素的存在支持在边缘和中间风险的患者中启动或加强他汀类药物治疗。但是，指南确实不量化增加风险的因素改变个人的10年风险，做出治疗的决定或者不治疗最终主观的增强风险因素的知情。健康的社会决定因素（SDOH）是重要的ASCVD风险因素。 PCE系统地低估了个人的风险被社会剥夺；但是，SDOH不包括在PCE中，或被认为是增强风险的因素当前的准则。此外，PCE的表现在西班牙裔和亚洲人，两者中值得怀疑在美国增长最快的少数群体。对于二级预防，2018年指南建议高级具有EZETIMIBE和PCSK9的2400万美国成年人的强度他汀类药物治疗建议针对反复发生ASCVD风险很高的子集的抑制剂，这是由多个病史定义的主要的ASCVD事件或一个具有多个高风险条件的主要事件。但是，最近的证据表明这个定义可能会将太多个体（> 50％）分类为具有很高的风险。此外，妇女，种族/族裔少数群体，而SDOH不利的人可能会有更高的经常性ASCVD风险，但是这些风险定义非常高的ASCVD风险时，目前的指南中未考虑因素。为了解决文献和指南中的这些差距，我们的研究建议1）量化多少每个增加风险增加因素（包括SDOH和西班牙裔和亚洲亚组）和不存在他们的组合将10年的ASCVD风险改变超出PCE预测； 2）确定算法优化反复发生ASCVD事件风险很高的个体的歧视； 3）比较美国成年人的健康，经济和健康公平影响降低脂质的人根据AIM 1和2与2018年胆固醇指南相比的方法，疗法。这项研究将开发方法，以提高美国成年人胆固醇治疗指南的精度，并有助于直接对具有高负担的族裔亚组和群体的治疗 ASCVD的高风险，但不建议通过当前的国家胆固醇指南进行治疗。发现从这项研究中，将为未来的准则提供信息，改善心血管结局和健康不平等。

项目成果

期刊论文数量（6）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Incidence of Atherosclerotic Cardiovascular Disease in Young Adults at Low Short-Term But High Long-Term Risk.

DOI：
10.1016/j.jacc.2022.11.051
发表时间：
2023-02-21
期刊：
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
影响因子：
24
作者：
An, Jaejin;Zhang, Yiyi;Zhou, Hui;Zhou, Mengnan;Safford, Monika M.;Muntner, Paul;Moran, Andrew E.;Reynolds, Kristi
通讯作者：
Reynolds, Kristi

Validation of ICD-10 hospital discharge diagnosis codes to identify incident and recurrent ischemic stroke from a US integrated healthcare system.

验证 ICD-10 出院诊断代码，以识别来自美国综合医疗保健系统的事件和复发性缺血性中风。

DOI：
10.1002/pds.5675
发表时间：
2023
期刊：
Pharmacoepidemiology and drug safety
影响因子：
2.6
作者：
Shirley,AbraelleM;Morrisette,KerresaL;Choi,SoonKyu;Reynolds,Kristi;Zhou,Hui;Zhou,MengnanM;Wei,Rong;Zhang,Yiyi;Cheng,Pamela;Wong,Eric;Sangha,Navdeep;An,Jaejin
通讯作者：
An,Jaejin

Trends of Elevated Low-Density Lipoprotein Cholesterol, Awareness, and Screening Among Young Adults in the US, 2003-2020.

2003-2020 年美国年轻人低密度脂蛋白胆固醇升高、意识和筛查的趋势。

DOI：
10.1001/jamacardio.2022.2641
发表时间：
2022
期刊：
JAMA cardiology
影响因子：
24
作者：
Zhang,Yiyi;An,Jaejin;Reynolds,Kristi;Safford,MonikaM;Muntner,Paul;Moran,AndrewE
通讯作者：
Moran,AndrewE

Reply: Understanding Myocardial Infarction in Young Individuals Now or in 30 Years?

回复：现在或30年后了解年轻人心肌梗塞？