Applying engineering in healthcare: a proposed computer-assisted mathematical model for atherosclerotic cardiovascular risk assessment

摘要

Despite major advances in the diagnosis and treatment of atherosclerotic cardiovascular disease (CVD) in the past century, it remains a serious clinical and public health problem. There is a need for a new cardiovascular disease model that includes a wider range of relevant risk factors, in particular lifestyle factors, to aid targeting of interventions and improve population models of the impact of cardiovascular disease and preventive strategies. The model needs to be applicable to a wider population including different ethnic groups, different countries and to those with and without cardiovascular disease. Separate multivariable risk algorithms are commonly used to assess risk of specific atherosclerotic cardiovascular disease events, i.e., coronary heart disease (CHD), cerebrovascular disease, peripheral vascular disease, and heart failure. In recent years a number of algorithms for cardiovascular risk assessment have been proposed to the medical community. These algorithms consider a number of variables and express their results as the percentage risk of developing a major fatal or non-fatal cardiovascular event in the following 10 to 20 years. Decades of evaluation of CVD risk factors by the Framingham Study led to the conclusion that CVD risk evaluation is most fruitfully appraised from the multivariable risk posed by a set of established risk factors. Such assessment is essential because risk factors seldom occur in isolation, and the risk associated with each varies widely depending on the burden of associated risk factors. Multivariable risk stratification is now recognized as essential in efficiently identifying likely candidates for CVD and quantifying the hazard. The present paper aims to propose a computer-assisted model for estimating short-term (10-years) risk for CHD or CHD risk-equivalents based on the steps proposed in the most validated risk-score algorithm, i.e., Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III).