基于《中国心血管病预防指南2017》的中青年高血压患者ASCVD危险评估及分层分析

Risk assessment and stratified analysis on atherosclerotic cardiovascular diseases in young and middleaged patients with hypertension based on Chinese Guidelines for Cardiovascular Disease Prevention 2017

目的 应用《中国心血管病预防指南2017》对中青年高血压患者进行动脉粥样硬化性心血管疾病(ASCVD)发病风险评估和分层,指导高血压患者对ASCVD的防治。方法 于2019年6月至2020年6月,连续纳入北京安贞医院心内科就诊的40~54岁高血压患者1442例,收集患者的基本信息、吸烟、生化检查及血压和体质指数等指标,应用《中国心血管病预防指南2017》进行ASCVD危险评估和分层。结果 患者平均年龄49.1±3.6岁,女性960例(66.6%)。依据指南的评估过程,第一步评估:429例患者(29.8%)直接定义为高危;对剩余1013例进行第二步评估:其中279例(27.5%)为低危,527例(52.0%)为中危,150例(14.8%)为高危;527例中危患者进行终生风险评估:65例(12.3%)确定为高危。最终分层结果:高危644例(44.7%)、中危462例(32.0%)、低危279例(19.3%)、57例(3.1%)未分层。57例未分层患者的低密度脂蛋白胆固醇(LDL-C)均<1.8 mmol/L(指南对于LDL-C<1.8 mmol/L的患者未提供分层建议)。去除未分层的57例患者,男性高危比例显著高于女性(69.4%vs.34.9%,P<0.001);三个分层患者间的血压、空腹血糖、LDL-C在目标值以下的比例均存在统计学差异(P<0.001)。结论 中青年高血压患者超过40%为ASCVD高危对象;高危患者血压、空腹血糖及LDL-C在目标值以下的比例均处于低水平,增加了ASCVD的发病风险;由于《中国心血管病预防指南2017》对于LDL-C<1.8 mmol/L的患者未提供分层建议,部分患者未能分层,ASCVD危险评估应在指南中进一步完善。

Objective To conduct the risk assessment and stratified analysis on atherosclerotic cardiovascular diseases(ASCVD) in young and middle-aged patients with hypertension based on Chinese Guidelines for Cardiovascular Disease Prevention 2017(the Guidelines).Methods The patients with hypertension(n=1442,aged from 40 to 54) were continuously chosen from June 2019 to June 2020.The basic data,smoking status and indexes of biochemical examinations,blood pressure(BP) and body mass index(BMI) were collected.ASCVD was given a risk assessment and stratified analysis by using the Guidelines.Results The average age of all patients was(49.1±3.6) years old and there were 960(66.6%) female cases.According to the assessment process of the Guidelines,there were 429 cases(29.8%) directly defined as high-risk population in the first step of assessment.In remained 1013 cases,there were 279 cases(27.5%) at low risk,527(52.0%) at medium risk,and 150(14.8%) at high risk in the second step of assessment.Lifetime risk assessment was performed on 527 intermediate-risk patients,and 65cases(12.3%) were identified as high-risk population.The final stratification results showed taht 644 cases(44.7%)were at high risk,462 cases(32.0%) were at medium risk,279 cases(19.3%) were at low risk and 57 cases(3.1%)were not stratified.There were 57 unstratified patients with mean level of low-density lipoprotein-cholesterol(LDL-C)<1.8 mmol/L(there were no stratification recommendations for patients with LDL-C<1.8 mmol/L in the Guidelines).Excluding the 57 patients without stratification,the proportion of males at high risk was significantly higher than that of females(69.4% vs.34.9%,P<0.001).The proportions of BP,fasting plasma glucose(FPG)and LDL-C below the target value had statistical difference among 3 stratifications(P<0.001).Conclusion More than 40% of young and middle-aged hypertensive patients are at high risk of ASCVD.In high-risk patients,the proportions of BP,FPG and LDL-C below the target value are all at lower level,which increases the risk of ASCVD.As the Guidelines does not provide stratification suggestions for the patients with LDL-C<1.8 mmol/L,and some patients fail to stratify,the risk assessment of ASCVD should be further improved in the Guidelines.