6个问题可预测心血管住院风险

火奴鲁鲁(檀香山)——根据亚拉巴马大学伯明翰分校的Virginia J. Howard医生在国际卒中大会上公布的一项大型全国性研究，凭借无卒中的普通人对6个问题的回答，对于在接下来5年内因心血管疾病住院或到急诊科就诊几率超过40%者的识别率可达18%。这一预测效能与传统心血管危险因素相当。

这份“鉴定无卒中状态问卷”，即QVSFS，包括下列问题：“你是否曾经身体一侧突发麻木或无感觉？”、“你是否曾经身体一侧突发无痛性无力？”、“你是否曾经单眼或双眼突发无痛性视力下降？” 、“你是否曾经突然失去语言或书面表达能力？”、“你是否曾经视力突然下降一半？”以及“你是否曾经突然失去理解他人说话的能力？”，可在进行常规患者评估期间轻松询问。尽管这些问题与卒中样症状有关，但也能预测其他心血管事件。

REGARDS即“卒中存在地域或种族差异的原因”研究，是一项前瞻性群体性纵向研究，涉及30,239名非裔美国人或白人，受试者的年龄均在45岁以上。这项全国性研究对非裔美国人过取样，占受试群体的40%。Howard医生将分析对象限定在26,673名受试者，其平均年龄为64岁，基线时无卒中或短暂性缺血发作(TIA)病史。在这些受试者中，有49%将自身的一般健康状况描述为极好或非常好，另外35%将其描述为好。但57%的受试者存在高血压，32%存在血脂代谢异常，21%患有糖尿病。

在平均5.6年的随访过程中，30%的受试者因心脏病、卒中(9%)或TIA而住院或到急诊科就诊。总共17.5%的受试者在基线时对≥1个问题做出肯定回答(如表所示)。对单个QVSFS问题给予肯定回答者占受试者的10.5%，对2个问题给予肯定回答者占4.6%，对3个问题给予肯定回答者占1.4%，对≥4个问题给予肯定回答者占0.9%。对≥1个问题做出肯定回答的受试者在随访期间因心血管疾病而住院或到急诊科就诊的几率大约是对这6个问题均做出否定回答者的2倍。

在一项校正人口学、社会经济状况、传统心血管危险因素以及自报告一般健康状况的多变量分析中，基线时对QVSFS有肯定回答者因心血管疾病而住院或到急诊科就诊的几率和因卒中而住院或到急诊科就诊的几率，分别较对这6个问题都做出否定回答者高出62%和47%。在完全校正后的多变量分析中，每多1个肯定回答，因心血管疾病而住院或到急诊科就诊的风险就增加29%，因卒中而住院或到急诊科就诊的风险就增加22%。就传统的心血管危险因素而论，高血压使患者因心血管疾病住院或到急诊科就诊的风险增加12%，糖尿病使患者因心血管疾病住院或到急诊科就诊的风险增加29%，使卒中风险增加43%。

REGARDS研究由国立神经疾病及卒中研究所资助。Howard医生无利益冲突披露。

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By: BRUCE JANCIN, Cardiology News Digital Network

HONOLULU – The answers to six questions can identify 18% of the stroke-free general population as having a greater than 40% chance of hospitalization or an emergency department visit for cardiovascular disease within the next 5 years, according to a large national study.

New evidence from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study indicates that the predictive power of the six questions compares to that of traditional cardiovascular risk factors, Virginia J. Howard, Ph.D., said at the International Stroke Conference sponsored by the American Heart Association.
 
These six questions – called the Questionnaire for Verifying Stroke-Free Status, or QVSFS – can easily be asked by office staff during a routine patient evaluation. Although the questions relate to strokelike symptoms, they also were predictive of other cardiovascular events.

REGARDS is a prospective, population-based, longitudinal study of 30,239 African Americans and whites over age 45. The national study oversampled African Americans, who made up 40% of the study population.

Dr. Howard’s analysis was restricted to the 26,673 subjects, mean age 64 years, with no baseline history of stroke or transient ischemic attack (TIA). Of these participants, 49% characterized their general health as excellent or very good, and another 35% described it as good. Yet 57% of subjects had hypertension, 32% were dyslipidemic, and 21% had diabetes.

During a mean 5.6 years of follow-up, 30% of subjects were hospitalized or had an emergency department visit for heart disease, stroke (9%), or TIA.

Fully 17.5% of subjects answered one or more of the questions affirmatively at baseline (see chart). Their rate of hospitalization or an ED visit for cardiovascular disease during the follow-up period was nearly twice that of patients who answered ‘no’ to all six questions.

In a multivariate analysis fully adjusted for demographics, socioeconomic status, conventional cardiovascular risk factors, and self-reported general health, subjects with any positive answer on the QVSFS at baseline had a 62% greater incidence of hospitalization or an ED visit for cardiovascular disease and a 47% greater incidence of hospitalization or a trip to the ED for stroke than did those who answered ‘no’ to all six questions, reported Dr. Howard of the University of Alabama, Birmingham.

A positive response to a single QVSFS question was provided by 10.5% of subjects. Another 4.6% gave affirmative answers to two questions, 1.4% did so for three, and 0.9% gave four or more positive answers.

In the fully adjusted multivariate analysis, each additional positive response was associated with an additional 29% increase in the risk of a cardiovascular hospitalization or ED visit and a 22% increase in the risk of a hospitalization or ED visit for stroke.

Looking at traditional cardiovascular risk factors, subjects with hypertension had a 12% greater risk of cardiovascular hospitalization or an ED visit and a 17% greater risk of stroke hospitalization or an ED visit. Diabetes conveyed a 29% greater risk of cardiovascular hospitalization or an ED visit and a 43% increase in stroke risk.

The REGARDS study is funded by the National Institute of Neurological Disorders and Stroke. Dr. Howard reported having no financial conflicts.