美国心脏学会/美国卒中学会卒中一级预防指南：十年磨一剑

doi:10.3969/j.issn.1673-5765.2024.12.002

摘要/Abstract

摘要： “十年磨一剑”——2024年12月，美国心脏学会/美国卒中学会发布了新版卒中一级预防指南。与2014年发布的上一版卒中一级预防指南相比，新指南强调关注宏观社会因素、整体评估和控制危险因素、全面预防（包括非动脉粥样硬化性卒中）、重视特殊人群和特殊危险因素。对于中等心脑血管疾病风险人群，目前卒中一级预防的研究证据尚不足以证实阿司匹林的有效性和安全性。需要结合多组学、人工智能、大数据和模拟随机对照试验等方法，选择以患者为中心的研究终点来完善证据，指导实践。

关键词: 卒中; 一级预防; 指南

Abstract: A ten-year effort is just for this day, the 2024 guideline for the primary prevention of stroke from the American Heart Association/American Stroke Association was published in December 2024. Compared to the previous edition in 2014, the 2024 guideline focuses on macro-social factors, overall evaluation and management of the risk factors, holistic prevention (including non-atherosclerotic stroke), and paying attention to special populations and specific risk factors. For people with a moderate risk of cardiovascular and cerebrovascular disease, the current research evidence for the primary prevention of stroke is not yet sufficient to confirm the effectiveness and safety of aspirin. Methods such as multi-omics, artificial intelligence, big data, and simulated randomized controlled trials need to be combined to select patient-centered research endpoints to refine the evidence and guide practice.

Key words: Stroke; Primary prevention; Guideline

中图分类号:

郑华光, 李昊, 王拥军. 美国心脏学会/美国卒中学会卒中一级预防指南：十年磨一剑[J]. 中国卒中杂志, 2024, 19(12): 1372-1375.

ZHENG Huaguang, LI Hao, WANG Yongjun. The 2024 Guideline for the Primary Prevention of Stroke: Ten Years of Hard and Persistent Effort[J]. Chinese Journal of Stroke, 2024, 19(12): 1372-1375.

参考文献

[1] BUSHNELL C，KERNAN W N，SHARRIEF A Z，et al. 2024 guideline for the primary prevention of stroke：a guideline from the American Heart Association/American Stroke Association[J/OL]. Stroke，2024，55（12）：e344-e424[2024-10-23]. https://doi.org/10.1161/str.0000000000000475.
[2] MESCHIA J F，BUSHNELL C，BODEN-ALBALA B，et al. Guidelines for the primary prevention of stroke：a statement for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke，2014，45（12）：3754-3832.
[3] PANDIAN J D，GALL S L，KATE M P，et al. Prevention of stroke：a global perspective[J]. Lancet，2018，392（10154）：1269-1278.
[4] OWOLABI M O，THRIFT A G，MAHAL A，et al. Primary stroke prevention worldwide：translating evidence into action[J/OL]. Lancet Public Health，2022，7（1）：e74-e85[2024-10-23]. https://doi.org/10.1016/s2468-2667（21）00230-9.
[5] SHERMAN R E，ANDERSON S A，DAL PAN G J，et al. Real-world evidence—what is it and what can it tell us?[J]. N Engl J Med，2016，375（23）：2293-2297.
[6] COLLINS R，BOWMAN L，LANDRAY M，et al. The magic of randomization versus the myth of real-world evidence[J]. N Engl J Med，2020，382（7）：674-678.
[7] HERNÁN M A，WANG W，LEAF D E. Target trial emulation：a framework for causal inference from observational data[J]. JAMA，2022，328（24）：2446-2447.
[8] MATTHEWS A A，DANAEI G，ISLAM N，et al. Target trial emulation：applying principles of randomised trials to observational studies[J/OL]. BMJ，2022，378：e071108[2024-10-23]. https://doi.org/10.1136/bmj-2022-071108.
[9] BIDULKA P，LUGO-PALACIOS D G，CARROLL O，et al. Comparative effectiveness of second line oral antidiabetic treatments among people with type 2 diabetes mellitus：emulation of a target trial using routinely collected health data[J/OL]. BMJ，2024，385：e077097[2024-10-23]. https://doi.org/10.1136/bmj-2023-077097.
[10] YANG Z，DENG Q J，HAO Y C，et al. Effectiveness of treat-to-target cholesterol-lowering interventions on cardiovascular disease and all-cause mortality risk in the community-dwelling population：a target trial emulation[J/OL]. Nat Commun，2024，15（1）：9922[2024-10-23]. https://doi.org/10.1038/s41467-024-54078-4.
[11] LI L，PANG S C，STARNECKER F，et al. Integration of a polygenic score into guideline-recommended prediction of cardiovascular disease[J]. Eur Heart J，2024，45（20）：1843-1852.
[12] DEBETTE S，CHASMAN D I. Multiomic approaches to stroke：the beginning of a journey[J]. Nat Rev Neurol，2024，20（2）：65-66.
[13] GARG M，KARPINSKI M，MATELSKA D，et al. Disease prediction with multi-omics and biomarkers empowers case-control genetic discoveries in the UK biobank[J]. Nat Genet，2024，56（9）：1821-1831.
[14] EVEN D，ABDALLA S M，MAANI N，et al. News media as a commercial determinant of health[J/OL]. Lancet Glob Health，2024，12（8）：e1365-e1369[2024-10-23]. https://doi.org/10.1016/s2214-109x（24）00191-8.
[15] SHAH N S，KANDULA N R，COMMODORE-MENSAH Y，et al. Social determinants of cardiovascular health in Asian Americans：a scientific statement from the American Heart Association[J/OL]. Circulation，2024，150（16）：e296-e315[2024-10-23]. https://doi.org/10.1161/cir.0000000000001278.
[16] WANG X，MA H，LI X，et al. Association of cardiovascular health with life expectancy free of cardiovascular disease，diabetes，cancer，and dementia in UK adults[J]. JAMA Intern Med，2023，183（4）：340-349.
[17] WATSON M C，NEIL K E. Social determinants of health：a positive manifesto for public health[J/OL]. BMJ，2024，385：q1275[2024-10-23]. https://doi.org/10.1136/bmj.q1275.
[18] SABA L，SAAM T，JÄGER H R，et al. Imaging biomarkers of vulnerable carotid plaques for stroke risk prediction and their potential clinical implications[J]. Lancet Neurol，2019，18（6）：559-572.
[19] BOS D，ARSHI B，VAN DEN BOUWHUIJSEN Q J A，et al. Atherosclerotic carotid plaque composition and incident stroke and coronary events[J]. J Am Coll Cardiol，2021，77（11）：1426-1435.
[20] MEINEL T R，KAESMACHER J，ROTEN L，et al. Covert brain infarction：towards precision medicine in research，diagnosis，and therapy for a silent pandemic[J]. Stroke，2020，51（8）：2597-2606.
[21] MEINEL T R，TRIULZI C B，KAESMACHER J，et al. Management of covert brain infarction survey：a call to care for and trial this neglected population[J]. Eur Stroke J，2023，8（4）：1079-1088.
[22] MOJADIDI M K，KUMAR P，MAHMOUD A N，et al. Pooled analysis of PFO occluder device trials in patients with PFO and migraine[J]. J Am Coll Cardiol，2021，77（6）：667-676.
[23] KALKMAN D N，COUTURIER E G M，EL BOUZIANI A，et al. Migraine and cardiovascular disease：what cardiologists should know[J]. Eur Heart J，2023，44（30）：2815-2828.
[24] SPOSATO L A，ALBIN C S W，ELKIND M S V，et al. Patent foramen ovale management for secondary stroke prevention：state-of-the-art appraisal of current evidence[J]. Stroke，2024，55（1）：236-247.
[25] SIMON T G，WILECHANSKY R M，STOYANOVA S，et al. Aspirin for metabolic dysfunction-associated steatotic liver disease without cirrhosis：a randomized clinical trial[J]. JAMA，2024，331（11）：920-929.
[26] CALVERT M，KYTE D，MERCIECA-BEBBER R，et al. Guidelines for inclusion of patient-reported outcomes in clinical trial protocols：the SPIRIT-PRO extension[J]. JAMA，2018，319（5）：483-494.
[27] CALVERT M，KYTE D，PRICE G，et al. Maximising the impact of patient reported outcome assessment for patients and society[J/OL]. BMJ，2019，364：k5267[2024-11-02]. https://doi.org/10.1136/bmj.k5267.
[28] KHERA R，BUTTE A J，BERKWITS M，et al. AI in medicine—JAMA’s focus on clinical outcomes，patient-centered care，quality，and equity[J]. JAMA，2023，330（9）：818-820.
[29] GOLDFARB M J，SAYLOR M A，BOZKURT B，et al. Patient-centered adult cardiovascular care：a scientific statement from the American Heart Association[J/OL]. Circulation，2024，149（20）：e1176-e1188[2024-11-02]. https://doi.org/10.1161/CIR.0000000000001233.
[30] CROWLEY R，PUGACH D，WILLIAMS M，et al. Principles for the physician-led patient-centered medical home and other approaches to team-based care：a position paper from the American College of Physicians[J]. Ann Intern Med，2024，177（1）：65-67.