Kardiyovasküler Hastalık Risk Hesaplama Sistemleri ve Yeni Bir Model: Prevent
Synopsis
Artan mortalite ve morbidite oranıyla kardiyovasküler hastalıklar (KVH) dünya çapında önde gelen bir halk sağlığı sorunu olarak görülmektedir. Davranışsal, metabolik ve çevresel birçok risk faktörünü barındıran KVH’lar, yaklaşık olarak yarısının önlenebilir risk faktörlerinden meydana geldiği düşünüldüğünde, sağlık maliyetlerini düşürmek, mortalite ve morbidite oranını azaltabilmek ve bireylerin yaşam kalitesini korumak açısından acil müdahale gerektirir. Dünya Sağlık Örgütü, Amerikan Kalp Birliği, Amerikan Kardiyoloji Koleji ve Avrupa Kardiyoloji Birliği gibi kuruluşlar tarafından geliştirilen, belirli risk faktörlerini dahil ederek KVH riskini hesaplayan sistemler, düşük riskli bireyler için yaşam tarzı değişikliğinin önerileri ile kardiyovasküler sağlıklarının korunması ve hastalık gelişiminin önlenebilmesi açısından, yüksek riskli bireyler için ise uygun tıbbi müdahalelerin planlanıp geliştirilmesi ve önleyici tedavi hedeflerinin belirlenmesi açısından sağlık hizmetlerine katkı sağlamaktadır. Bu bölümde; KVH’ların önlenmesi için risk değerlendirme araçlarının kullanımının önemini vurgulanması ve diğer risk tahmin sistemleri ile birlikte yeni risk değerlendirme araçlarından birisi olan PREVENT sisteminin açıklanması amaçlanmıştır.
With increasing mortality and morbidity rates, cardiovascular diseases (CVDs) are recognized as a leading public health problem worldwide. CVDs, which involve many behavioral, metabolic and environmental risk factors, require urgent intervention in order to reduce health costs, reduce mortality and morbidity rates and protect the quality of life of individuals, considering that approximately half of them are preventable risk factors. Systems developed by organizations such as the World Health Organization, the American Heart Association, the American College of Cardiology and the European Society of Cardiology, which calculate CVD risk by including certain risk factors, contribute to health services in terms of protecting cardiovascular health and preventing the development of disease by recommending lifestyle changes for low-risk individuals, and planning and developing appropriate medical interventions for high-risk individuals and determining preventive treatment goals. In this chapter; it is aimed to emphasize the importance of using risk assessment tools for the prevention of CVDs and to explain the PREVENT system, which is one of the new risk assessment tools along with other risk prediction systems.
References
Budreviciute A, Damiati S, Sabir DK, Onder K, Schuller-Goetzburg P, Plakys G, et al. Management and Prevention Strategies for Non-communicable Diseases (NCDs) and Their Risk Factors. Front Public Health. 2020 Nov 26;8.
World Health Organization, Top 10 causes of death, 21.10.2024 tarihinde https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death adresinden ulaşılmıştır.
Habib SH, Saha S. Burden of non-communicable disease: Global overview. Diabetes Metab Syndr. 2010 Jan;4(1):41–7.
Kyu HH, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1859–922.
Trimarchi G, Pizzino F, Paradossi U, Gueli IA, Palazzini M, Gentile P, et al. Charting the Unseen: How Non-Invasive Imaging Could Redefine Cardiovascular Prevention. J Cardiovasc Dev Dis. 2024 Aug 9;11(8):245.
World Health Organization, Cardiovascular diseases (CVDs), 23.10.2024 tarihinde https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds) adresinden ulaşılmıştır.
Vaduganathan M, Mensah GA, Turco JV, Fuster V, Roth GA. The Global Burden of Cardiovascular Diseases and Risk. J Am Coll Cardiol. 2022 Dec;80(25):2361–71.
van Daalen KR, Zhang D, Kaptoge S, Paige E, Di Angelantonio E, Pennells L. Risk estimation for the primary prevention of cardiovascular disease: considerations for appropriate risk prediction model selection. Lancet Glob Health. 2024;12(8):e1343–58.
Varadarajan V, Gidding SS, Wu C, Carr JJ, Lima JAC. Imaging Early Life Cardiovascular Phenotype. Circ Res. 2023 Jun 9;132(12):1607–27.
Talha I, Elkhoudri N, Hilali A. Major Limitations of Cardiovascular Risk Scores. Cardiovasc Ther. 2024 Feb 28;2024:1–6.
Dülek H, Vural ZT, Gönenç İ. Kardiyovasküler Hastalıklara Etki Eden Faktörlerin Değerlendirilmesi ve Kardiyovasküler Risk Skorlamalarının Karşılaştırılması. Dicle Tıp Dergisi. 2019 Sep 16;46(3):449–59.
Berger JS, Jordan CO, Lloyd-Jones D, Blumenthal RS. Screening for Cardiovascular Risk in Asymptomatic Patients. J Am Coll Cardiol. 2010 Mar;55(12):1169–77.
Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019 Sep 10;140(11).
Bansilal S, Castellano JM, Fuster V. Global burden of CVD: focus on secondary prevention of cardiovascular disease. Int J Cardiol. 2015 Dec;201:S1–7.
Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J. 2016 Oct 14;37(39):2999–3058.
Navarini L, Margiotta DPE, Costa L, Currado D, Tasso M, Angeletti S, et al. Performance and calibration of the algorithm ASSIGN in predicting cardiovascular disease in Italian patients with psoriatic arthritis. Clin Rheumatol. 2019 Apr 2;38(4):971–6.
Khan SS, Matsushita K, Sang Y, Ballew SH, Grams ME, Surapaneni A, et al. Development and Validation of the American Heart Association’s PREVENT Equations. Circulation. 2024 Feb 6;149(6):430–49.
Dent THS. Predicting the risk of coronary heart disease. Atherosclerosis. 2010 Dec;213(2):345–51.
Mahmood SS, Levy D, Vasan RS, Wang TJ. The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective. Lancet. 2014;383(9921):999–1008.
Framingham Heart Study, 13.11. 2024 tarihinde https://www.framinghamheartstudy.org/files/2023/11/Exam-Dates-Table-Thru-2022.pdf adresinden ulaşılmıştır.
D’Agostino Sr. RB, Pencina MJ, Massaro JM, Coady S. Cardiovascular Disease Risk Assessment: Insights from Framingham. Glob Heart. 2013 Mar 1;8(1):11.
Framingham Heart Study, About the Framingham Heart Study, 13.11.2024 tarihinde https://www.framinghamheartstudy.org/fhs-about/ adresinden ulaşılmıştır.
Grundy SM, Balady GJ, Criqui MH, Fletcher G, Greenland P, Hiratzka LF, et al. Primary Prevention of Coronary Heart Disease: Guidance From Framingham. Circulation. 1998 May 12;97(18):1876–87.
The framıngham heart study, layıng the foundatıon for preventıve health care, 29.11.2024 tarihinde https://www.framinghamheartstudy.org/files/2021/07/FHS-Laying-the-Foundation-from-NIH.pdf adresinden ulaşılmıştır.
D’Agostino RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General Cardiovascular Risk Profile for Use in Primary Care. Circulation. 2008 Feb 12;117(6):743–53.
Kasim SS, Ibrahim N, Malek S, Ibrahim KS, Aziz MF, Song C, et al. Validation of the general Framingham Risk Score (FRS), SCORE2, revised PCE and WHO CVD risk scores in an Asian population. Lancet Reg Health West Pac. 2023 Jun;35:100742.
The Emerging Risk Factors Collaboration. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010 Jun;375(9733):2215–22.
Paynter NP, Everett BM, Cook NR. Cardiovascular Disease Risk Prediction in Women: Is There a Role for Novel Biomarkers? Clin Chem. 2014 Jan 1;60(1):88–97.
Menotti A. Comparison of the Framingham risk function-based coronary chart with risk function from an Italian population study. Eur Heart J. 2000 Mar 1;21(5):365–70.
Conroy R. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003 Jun;24(11):987–1003.
Csenteri O, Jancsó Z, Szöllösi GJ, Andréka P, Vajer P. Differences of cardiovascular risk assessment in clinical practice using SCORE and SCORE2. Open Heart. 2022 Nov 28;9(2):e002087.
T.C. Sağlık Bakanlığı, Halk Sağlığı Genel Müdürlüğü, bı̇rı̇ncı̇ basamak sağlık hı̇zmetlerı̇nde koroner arter hastalığı ı̇çı̇n ı̇zlem kılavuzu, 01.12.2024 tarihinde https://hsgm.saglik.gov.tr/depo/birimler/kronik-hastaliklar-ve-yasli-sagligi-db/Dokumanlar/Rehberler/Koroner_Arter_Kilavuzu.pdf adresinden ulaşılmıştır.
Civek S, Akman M. Frequency and risk Assessment of cardiovascular diseases in the world and Turkey. The Journal of Turkish Family Physician. 2022 Mar 30;13(1):21–8.
Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021 Sep 7;42(34):3227–337.
Hageman S, Pennells L, Ojeda F, Kaptoge S, Kuulasmaa K, de Vries T, et al. SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. Eur Heart J. 2021 Jul 1;42(25):2439–54.
World Health Organization, Prevention of Cardiovascular Disease, 01.12.2024 tarihinde https://iris.who.int/bitstream/handle/10665/43786/9789241547253_eng.pdf?sequence=1 adresinden ulaşılmıştır.
Ridker PM, Buring JE, Rifai N, Cook NR. Development and Validation of Improved Algorithms for the Assessment of Global Cardiovascular Risk in Women. JAMA. 2007 Feb 14;297(6):611.
Ridker PM, Paynter NP, Rifai N, Gaziano JM, Cook NR. C-Reactive Protein and Parental History Improve Global Cardiovascular Risk Prediction. Circulation. 2008 Nov 25;118(22):2243–51.
Khan SS, Lloyd-Jones DM. Statins for Primary Prevention of Cardiovascular Disease—With PREVENT, What’s a Clinician to Do? JAMA. 2024 Sep 24;332(12):961.
