Исследована информативность модели SCORE в оценке суммарного 10-летнего сердечно-сосудистого риска в изолированной выборке 207 лиц мужского пола, не имевших клинических проявлений атеросклероза. Выявлено, что большую часть наблюдений из числа лиц, достигших на протяжении данного периода времени комбинированной конечной точки, модели классифицируют неверно, что совершенно не удовлетворяет требованиям индивидуальной оценки риска в анализируемой ограниченной выборке. Показано, что включение маркеров субклинического атеросклероза в модель SCORE позволяет значительно улучшить ее чувствительность. В то же время в группу неблагоприятного прогноза попадает значительное количество наблюдений для лиц, свободных от сердечно-сосудистых событий, в связи с высокой вероятностью ложноположительного ответа.
Ключевые слова: атеросклероз, сердечно-сосудистые события, комбинированная конечная точка, модель SCORE, атеросклеротическая бляшка, толщина комплекса интима–медиа.
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The information content of SCORE model in the evaluation of the total ten-year cardiovascular risk in an isolated sample of 207 males without clinical manifestations of atherosclerosis was investigated. It was revealed that the most of the observations from persons who had attained over a 10-year period of the combined end point, the model qualified incorrectly, which didn’t meet the requirements of individual risk assessment in a limited sample group of males. It is shown that the inclusion of subclinical atherosclerosis markers in SCORE model can significantly improve its sensitivity. At the same time, a group of poor prognosis gets a significant number of observations for individuals free of cardiovascular events due to the high probability of false positive response.
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1. European guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2003; 24: 1601–10.
2. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486–97.
3. Rodgers A, Ezzati M, Vander Hoorn S et al. Distribution of major health risks: findings from the Global Burden of Disease study. PLoS Med 2004; 1: e27.
4. Ajani UA, Ford ES. Has the risk for coronary heart disease changed among U.S. adults? J Am Coll Cardiol 2006; 48: 1177–82.
5. Rogoza A.N. i dr. Sovremennye metody otsenki sostoianiia sosudov u bol'nykh arterial'noi gipertoniei. M.: RKNPK, 2008. [in Russian]
6. Stein JS, Korcarz CE, Post WS. Use of Carotid Ultrasound to Identify Subclinical Vascular Disease and Evaluate Cardiovascular Disease Risk: Summary and Discussion of the American Society of Echocardiography Consensus Statement. Prevent Cardiol 2009; p. 34–8.
7. Catapano AL, Reiner Z, De Backer G et al. ESC/EAS Guidelines for the management of dyslipidaemias. The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society. Atherosclerosis 2011; 217S: S1–S44.
8. Taylor A, Merz C, Udelson J. Executive Summary – Can Atherosclerosis Imaging Techniques Improve the Detection of Patients at Risk for Ischemic Heart Disease? J Am Coll Cardiol 2003; 41 (11): 31–7.
1 ФГБВОУ ВПО Военно-медицинская академия им. С.М.Кирова Минобороны России. 194044, Россия, Санкт-Петербург, ул. Академика Лебедева, д. 6;
2 ФГБОУ ВПО Санкт-Петербургский государственный университет. 199034, Россия, Санкт-Петербург, Университетская наб., д. 7/9
*cardioclinik@list.ru
1 Medico-military academy named after Kirov. 194044, Russian Federation, Saint Petersburg, ul. Akademika Lebedeva, d. 6;
2 Saint-Petersburg State University. 199034, Russian Federation, Saint Petersburg, Universitetskaia nab., d. 7/9
*cardioclinik@list.ru