2022台灣血脂治療指引(英文版)下面中文使用google自動翻譯
風險計算
對於初級預防，通常使用基於人群研究的動脈粥狀硬化性心血管疾病（ASCVD）風險評估計算，例如弗雷明漢風險評分，來決定受試者是否應接受降血脂治療。近年來，美國心臟病學會（ACC）和美國心臟協會（AHA）開發了合併隊列方程式。歐洲心臟學會（ESC）和歐洲動脈粥狀硬化學會（EAS）使用SCORE（系統性冠狀動脈風險評估）進行ASCVD風險評估。英國國家健康與臨床優化研究所（NICE）指引使用QRISK2作為ASCVD風險評估工具。儘管有許多針對特定族群的風險評估工具，但目前尚無任何模式源自東亞族群或經過前瞻性驗證。美國心臟協會/美國心臟病學會 (AHA/ACC) 總結隊列方程式用於估算 40 至 79 歲黑人和非西班牙裔白人男性和女性的 10 年 ASCVD 事件風險。 此風險預測指標可能高估了華人族群的 ASCVD 風險。 Framingham 風險評分也高估了華裔族群的 ASCVD 風險。
在台灣，20 世紀 90 年代，基於金山社區心血管隊列研究開發了一種基於積分的 10 年冠心病 (CAD) 風險預測模型。 然而，該模型並未明確定義高風險的臨界值。一些檢查，例如踝臂指數、脈搏波速度、頸動脈超音波和冠狀動脈鈣化評分，已被用於 ASCVD 風險評估。這些檢查在地方診所的可近性是一個主要問題。此外，冠狀動脈鈣化評分檢查的費用和輻射暴露也是需要考慮的重要因素。基本上，該指南並不鼓勵對無症狀族群進行亞臨床動脈粥狀硬化的常規篩檢。目前，在台灣，使用危險因子的數量進行風險分層更為便利。
Risk calculator
For primary prevention, population study-derived ASCVD risk estimate calculators, such as the Framingham risk score, are commonly used to decide whether a subject should receive lipid-lowering therapy or not. In recent years, the American College of Cardiology (ACC) and the American Heart Association (AHA) developed the pooled cohort equation.15,16 The European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) used SCORE (Systematic COronary Risk Evaluation) for ASCVD risk assessment.17,18 The UK National Institute for Health and Care Excellence (NICE) guidelines used the QRISK2 as the ASCVD risk assessment tool.19 Although several populationspecific risk assessment tools exist, none of the currently available models are derived from or prospectively validated in East Asians. The AHA/ACC pooled cohort equation for estimating the 10-year risk of ASCVD event is applicable to black and non-Hispanic white men and women 40 through 79 years of age.15 This risk predictor may overestimate the ASCVD risk in the Chinese population.20 The Framingham risk score also overestimated the ASCVD risk for ethnic Chinese.21 In Taiwan, a point-based prediction model to predict the 10-year risk of CAD was developed from the Chin-Shan Community Cardiovascular Cohort study in 1990s.22 However, the definite cut-off point to define high risk was not indicated. Some examinations, such as ankle-brachial index, pulse wave velocity, carotid ultrasound, and coronary calcium score, have been used in ASCVD risk assessment. The accessibility of these examinations is a major problem in local clinics. Concerns of cost and radiation exposure for examination of coronary calcium score are also important considerations. Basically, this guideline does not encourage to routinely screen the presence of subclinical atherosclerosis in asymptomatic subjects. At current stage, using the numbers of risk factors is a more convenient way for risk stratification in Taiwan.
Risk calculator
For primary prevention, population study-derived ASCVD risk estimate calculators, such as the Framingham risk score, are commonly used to decide whether a subject should receive lipid-lowering therapy or not. In recent years, the American College of Cardiology (ACC) and the American Heart Association (AHA) developed the pooled cohort equation.15,16 The European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) used SCORE (Systematic COronary Risk Evaluation) for ASCVD risk assessment.17,18 The UK National Institute for Health and Care Excellence (NICE) guidelines used the QRISK2 as the ASCVD risk assessment tool.19 Although several populationspecific risk assessment tools exist, none of the currently available models are derived from or prospectively validated in East Asians. The AHA/ACC pooled cohort equation for estimating the 10-year risk of ASCVD event is applicable to black and non-Hispanic white men and women 40 through 79 years of age.15 This risk predictor may overestimate the ASCVD risk in the Chinese population.20 The Framingham risk score also overestimated the ASCVD risk for ethnic Chinese.21 In Taiwan, a point-based prediction model to predict the 10-year risk of CAD was developed from the Chin-Shan Community Cardiovascular Cohort study in 1990s.22 However, the definite cut-off point to define high risk was not indicated. Some examinations, such as ankle-brachial index, pulse wave velocity, carotid ultrasound, and coronary calcium score, have been used in ASCVD risk assessment. The accessibility of these examinations is a major problem in local clinics. Concerns of cost and radiation exposure for examination of coronary calcium score are also important considerations. Basically, this guideline does not encourage to routinely screen the presence of subclinical atherosclerosis in asymptomatic subjects. At current stage, using the numbers of risk factors is a more convenient way for risk stratification in Taiwan.
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