两种十年动脉粥样硬化性心血管疾病发病风险评估工具在社区老年人群中的应用效果比较

Comparison of Two 10-year Risk Assessment Tools for Atherosclerotic Cardiovascular Disease in Community Elderly Population

目的比较10年动脉粥样硬化性心血管疾病(ASCVD)发病危险评估模型和基于中国动脉粥样硬化性心血管疾病风险预测(China-PAR)风险评估模型在社区老年人群中的应用效果。方法采用便利抽样法选取2020年5—8月在江苏省镇江市大市口社区卫生服务中心、健康路社区卫生服务中心和黎明社区卫生服务中心进行健康体检的老年人为调查对象。采用一般资料调查问卷对其进行调查,采用10年ASCVD发病危险评估模型和China-PAR风险评估模型评估其ASCVD风险。结果共发放问卷900份,回收有效问卷864份,有效回收率为96.0%。864例社区老年人中,男359例(41.6%),女505例(58.4%);吸烟169例(19.6%),饮酒130例(15.0%),超重或肥胖473例(54.7%),高血压476例(55.1%),高脂血症293例(33.9%),糖尿病194例(22.5%),代谢综合征(MS)469例(54.3%),心血管疾病主要危险因素个数≥3个242例(28.0%)。两种10年ASCVD发病风险评估工具评估结果的Kappa值为0.401。China-PAR风险评估模型评估的ASCVD高危老年人占比高于10年ASCVD发病危险评估模型评估的ASCVD高危老年人占比(P<0.05)。10年ASCVD发病危险评估模型评估的ASCVD低中危老年人中男性、75~80岁者、有高血压者占比高于China-PAR风险评估模型评估的ASCVD低中危老年人,65~69岁者占比低于China-PAR风险评估模型评估的ASCVD低中危老年人(P<0.05)。10年ASCVD发病危险评估模型评估的ASCVD高危老年人中女性、65~69岁者、有糖尿病者、心血管疾病主要危险因素个数≥3个者占比高于China-PAR风险评估模型评估的ASCVD高危老年人,75~80岁者占比低于China-PAR风险评估模型评估的ASCVD高危老年人(P<0.05)。结论社区老年人群10年ASCVD发病风险中高危者检出率较高,10年ASCVD发病危险评估模型与China-PAR风险评估模型预测结果一致性一般,用于ASCVD风险评估时,应充分考虑两种工具的特点,其中China-PAR风险评估模型可识别出更多的ASCVD高危人群。

Objective To compare the application effect of the 10-year atherosclerotic cardiovascular disease(ASCVD)risk assessment model and prediction for ASCVD risk in China(China-PAR)risk assessment model in community elderly population.Methods The elderly who underwent physical examination in Dashikou Community Health Service Center,Jiankang Road Community Health Service Center and Liming Community Health Service Center in Zhenjiang city Jiangsu province from May to August 2020 were selected by convenience sampling method.They were investigated by general information questionnaire,and 10-year ASCVD risk assessment model and China-PAR risk assessment model were used to assess their ASCVD risk.Results A total of 900 questionnaires were distributed and 864 valid questionnaires were recovered,with an effective recovery rate of 96.0%.Among the 864 elderly people in the community,359 cases(41.6%)were male and 505 cases(58.4%)were female;169 cases(19.6%)smoked,130 cases(15.0%)drank alcohol,473 cases(54.7%)were overweight or obese,476 cases(55.1%)had hypertension,293 cases(33.9%)had hyperlipidemia,194 cases(22.5%)had diabetes,469 cases(54.3%)had metabolic syndrome(MS),242 cases(28.0%)had≥3 major risk factors for cardiovascular disease.The Kappa value of the two 10-year ASCVD risk assessment tools was 0.401.The proportion of elderly at high risk of ASCVD assessed by China-PAR risk assessment model was higher than that assessed by 10-year ASCVD risk assessment model(P<0.05).The proportion of men,75-80 years old,and those with hypertension among the elderly at low and intermediate risk of ASCVD assessed by the 10-year ASCVD risk assessment model was higher than that of the elderly at low and intermediate risk of ASCVD assessed by the China-PAR risk assessment model,and the proportion of people aged 65-69 years was lower than that of the elderly at low and intermediate risk of ASCVD assessed by the China-PAR risk assessment model(P<0.05).The proportion of women,65-69 years old,those with diabetes,and≥3 major risk factors for cardiovascular disease among the elderly at high risk of ASCVD assessed by the 10-year ASCVD risk assessment model was higher than that assessed by the China-PAR risk assessment model,and the proportion of people aged 75-80 was lower than that of the elderly at high risk of ASCVD assessed by the China-PAR risk assessment model(P<0.05).Conclusion The detection rate of high-risk patients with 10-year ASCVD is higher in the elderly population in the community.The consistency between the 10-year ASCVD risk assessment model and the China-PAR risk assessment model is general,and the characteristics of the two tools should be fully considered when used for ASCVD risk assessment,and the China-PAR risk assessment model can identify more ASCVD high-risk population.