《国际循环》:众所周知,无论是男性还是女性,肥胖都是危险因素,但是肥胖男性与肥胖女性是否存在区别?相对于男性来说,女性肥胖是否带来了更大的风险?肥胖对于危险性的影响在男女间是否存在差异?
<International Circulation>: When it comes to risk stratification, do you think that the Framingham Risk Score and the Reynolds Risk Score adequately address some of the issues that you see in women?
《国际循环》:谈到危险分层,您认为弗兰明翰风险评分和雷诺兹风险评分是否能充分的说明女性中存在的一些问题?
Prof. Wenger:We have a new guideline that came out in December, the American Heart Association/ American College of Cardiology Risk Stratification in Asymptomatic Adults, and we acknowledged that the Framingham Risk Score underestimates the risk in women. There are many women who have subclinical indicators and who have a low Framingham Risk Score. Also the Framingham is so age-dependent that it is very hard for women to get high risk in Framingham. So that was not adequate. There is a new Framingham risk schedule that addresses cardiovascular and that is where the women begin to catch up but the fact of the matter is that physicians do not use these risk scores but use a gestalt look at the patient. That is why we simplified the risk stratification in the new women’s guidelines using the high-risk, the at-risk and ideal cardiovascular health because we thought that was a lot simpler and reflects the research studies that have been done either in healthy women or in sick women. They didn’t look at intermediate risk groups – so we know who is at high-risk and we know who is in ideal health and everyone else is at-risk.
Wenger教授:在12月我们会有一个新的指南出版,美国心脏协会/美国心脏病学学会对于无症状成年人的危险分层。同时我们也意识到弗兰明翰风险评分低估了妇女的风险。有许多的有亚临床指标的女性的弗兰明翰风险评分较低,并且弗兰明翰体系太过依赖年龄,因此女性要得到高评分是非常困难的,因此这些是不够的。新的弗兰明翰风险目录能够应对心血管疾病并且女性也适用。但事实上,医生并不使用这些风险评分而是通过病人的临床表现来判断。这就是我们为什么在新的女性标准中简化危险分层而采用高危、中危和理想的心血管健康。因为我们认为这样更简单并且能够反映在健康或患病妇女。没有包括中危组-我们知道哪些是高危的和理想健康状态的,那么其他是就介于两者间的危险人群。