Name: 2026年2月6日 心臟學週報！ (Feb 06 2026 This Week in Cardiology)
Uploaded: 2026-02-19T21:23:47.000Z
Duration: 23 min 42 s

You're listening to this Week in Cardiology from theheart.org Medscape Cardiology.

這是來自 theheart.org Medscape Cardiology 的「本週心臟學」節目。

情態副詞

This podcast is intended for healthcare professionals only.

本 Podcast 僅供醫療專業人士收聽。

Any views expressed are the presenter's own and do not necessarily reflect the views of WebMD or Medscape.

節目中表達的任何觀點僅代表講者個人，不一定反映 WebMD 或 Medscape 的立場。

Hi everyone, this is John Mandrola from the heart.org Medscape Cardiology.

大家好，我是來自 theheart.org Medscape Cardiology 的 John Mandrola。

And this is this Week in Cardiology for February 6, 2026.

這是 2026 年 2 月 6 日的「本週心臟學」。

This week, some more problems with the prevent risk equation.

這週，prevent risk equation 又出現了一些問題。

A new breakthrough in lipid lowering therapy, an even more surprising benefit in stroke care, and

降血脂治療有了新突破，中風照護的益處更是令人驚喜，還有

some more thoughts on statins and preventive care of heart disease.

關於 statins 和心臟病預防性照護的一些新想法。

So the first topic today is prevent score problems.

所以今天第一個要談的主題是 prevent score 的問題。

Now in the old days we used risk scores like Framingham and the pooled cohort equation or pce.

以前我們使用 Framingham 和 pooled cohort equation 或 pce 這類的風險評分。

These weren't perfect, but they were decent.

這些過去的評分雖然不完美，但還算不錯。

Recently, key opinion leaders have come up with a new score called the prevent score which is supposed to be better because it includes 30 to 39 year olds and that expands the age range.

最近，意見領袖提出了一個新的評分叫做 prevent score，據說它更好，因為包含了 30 到 39 歲的族群，擴大了年齡範圍。

它納入了心臟衰竭，而不只是 ascvd。

It removes race as a predictor, supposedly improving equity, and

它移除了種族作為預測因子，據說能提升公平性，而且

it adds optimal social determinants index and also includes kidney function.

它加入了最佳的社會決定因素指數，也納入了腎功能。

I think perhaps the most valuable or beneficial thing with the prevent score is it's derived from more recent data and therefore better reflects modern cardiovascular epidemiology.

我認為 prevent score 最有價值或最棒的一點是，它來自於較新的數據，是以能更好地反映現代的心血管流行病學。

Now finally, let's not forget the point of these risk scores.

現在，最後，我們別忘了這些風險評分的用意。

The risk scores are used to guide treatment.

Now, instead of treat everyone with say a blood pressure of 135 over 90, the risk score suggests treatment if a global 10 year risk reaches some set out threshold.

現在，與其治療所有血壓達到 135/90 的人，風險評分建議當整體的 10 年風險達到某個設定的閾值時才進行治療。

Now I go on about this because of a very very provocative paper published in JAC from the Kaiser Permanente Group on using the prevent equations in young adults.

接下來我會多講一點，因為有一篇發表在 JAC 的非常引人注目的論文，是來自 Kaiser Permanente Group，探討在年輕成人中使用 prevent equations。

This group assessed performance and algorithmic fairness of base n social determinant index augmented prevent equations in young adults age 30 to 39 and defined fairness as similar performance across racial and ethnic groups.

這個團隊評估了在 30 到 39 歲年輕成人中，加入社會決定因素指數的 prevent equations 的表現和演算法的公平性，並將公平性定義為在不同種族和族裔群體之間有相似的表現。

They then did an exploratory analysis conducted among young adults aged 20 to 29 years.

接著，他們對 20 到 29 歲的年輕成人進行了探索性分析。

Now this was a big data study including 160,000 plus young adults with varying races and ethnic groups.

這是一項包含超過 16 萬名不同種族和族裔背景的年輕成人的大數據研究。

The total incidence of cardiovascular disease was very low at 0.7%, which you'd expect because these are young people.

心血管疾病的總發生率非常低，只有 0.7%，這也是可以預期的，因為他們都是年輕人。

The main finding was that the mean calibration found severe under prediction in non Hispanic black individuals.

主要發現是，平均校準發現非西班牙裔黑人的預測嚴重不足。

Well, the prevent score underestimated risk by 46% in this group.

嗯，在這個群體中，prevent score 低估了 46% 的風險。

And of course this is very important because it could lead to substantial undertreatment of black individuals with life saving cholesterol and blood pressure meds.

這當然非常重要，因為這可能導致對黑人族群的挽救生命的膽固醇和血壓藥物治療不足。

The authors assessed whether adding the Social Determinant index would improve calibration in black individuals, but

作者評估了加入社會決定因素指數是否能改善黑人群體的校準，但

So my comments it's ironic that the tool meant to prevent undertreatment of young adults may actually cause undertreatment of young black adults, specifically the exact population with the highest premature cardiovascular disease burden.

所以我的評論是，這個旨在預防年輕人治療不足的工具，諷刺的是，反而可能導致年輕的非裔美國人治療不足，特別是那些早發性心血管疾病負擔最高的族群。

I could use a simple example for instance of a non Hispanic Black individual age 35.

我可以舉個簡單的例子，比如一個35歲的非西班牙裔黑人。

The blood pressure 135 over 85 on no meds prevent score predicts a 4% 10 year cardiovascular disease risk.

血壓135/85，沒有服藥，prevent score 預測10年心血管疾病風險為4%。

So the clinician sees 4%, says low risk, let's try lifestyle medications first, follow up in six months.

所以醫生看到4%，覺得是低風險，先試試生活方式的調整，六個月後再追蹤。

But it probably ought to be this is moderate risk indicating treatment is best to do now.

但實際上應該是中度風險，表示現在就開始治療是最好的。

Meanwhile a Hispanic patient with identical values, the prevent score predicts 4%, the true risk is about 4% and that patient can get appropriate conservative management.

同時，一位價值觀相同的西班牙裔患者，prevent score 預測為4%，真實風險約為4%，這位患者可以得到適當的保守治療。

Now I've said this a blue million times on this podcast, but

我在這個podcast上已經說過無數次了，

prediction is hard, especially about the future.

Like Yogi Berra said recently, I got kind of smashed on social media for suggesting a young woman needn't take statins because her overall risk was so low.

就像 Yogi Berra 最近說的，我因為建議一位年輕女性不需要吃 statins，因為她的總體風險很低，結果在社群媒體上被罵慘了。

Many suggested that we should treat regardless of overall risk, the thinking being that atherosclerosis is a slowly developing problem and the longer exposure to to lower LDL cholesterol or lower blood pressure is going to be beneficial.

很多人認為我們應該不顧總體風險就開始治療，他們的想法是動脈粥狀硬化是個緩慢發展的問題，越早降低 LDL 膽固醇或血壓，長期下來對身體就越好。

But if you take that logic to its natural end, we may as well start in the teen years or even younger and then just treat everyone.

但如果照這個邏輯走下去，我們乾脆從青少年時期甚至更早就開始治療，然後就這樣治療所有人好了。

There must be some happy medium where we use risk to guide therapy.

我們必須找到一個折衷點，用風險來引導治療。

Perhaps we don't have to hew so strongly to certain thresholds.

也許我們不必那麼嚴格地遵守某些門檻。

For instance, there's nothing magic about this 7.5% risk threshold.

舉例來說，7.5% 的風險門檻並沒有什麼特別神奇之處。

The thing that strikes me about this paper is that epidemiology clearly tells us that non Hispanic black individuals have higher cardiovascular risk on average.

這篇論文讓我印象深刻的是，流行病學清楚告訴我們，非西班牙裔的黑人平均來說心血管風險較高。

And at least in this population studied, the prevent score led to underestimation of risk and this could lead to or would lead to significant undertreatment if everybody just went by the risk scores.

而且至少在這項研究的族群中，prevent score 導致低估了風險，如果每個人都只看風險評分，這可能會導致嚴重的治療不足。

Now the risk score that was designed to be race neutral performed worse on race and it's kind of a head shaker.

現在，這個原本設計為種族中立的風險評分，在種族方面的表現反而更差，這真是讓人傻眼。

If I had a dollar for every instance in medicine where well intentioned policy led to harm.

如果我在醫學上每遇到一次好心辦壞事的情況，我都能賺到一塊錢。

Like things like the Healthcare Readmission Reductions Program which penalized hospitals for high rates of readmissions may have actually led to higher mortality and heart failure.

像是「醫療再入院削減計畫」，這個計畫懲罰再入院率高的醫院，結果可能反而導致了更高的死亡率和心臟衰竭。

Many years ago I visited the EPI lab of Dr.

很多年前，我參觀了戴夫·威爾伯醫師在芝加哥的流行病學實驗室，我永遠都忘不了。

Dave Wilber in Chicago and I'll never forget it.

在他的刺激器上方，掛著一個大字寫著：「抵抗幫助的衝動」。

Over his stimulator he had a sign that read in big letters, resist the urge to help.

或許我們在政策上也需要多一點這樣的精神。

And perhaps we need more of that in policy.

好的，下一個話題是口服 PCSK9 抑制劑在 LDL 膽固醇管理上的新突破。

All right, next topic is a new breakthrough in LDL cholesterol management with an oral PCSK9 inhibitor.

《新英格蘭醫學雜誌》發表了口服 PCSK9 藥物 in licitide 的 Coral Reef Lipids 試驗結果。

New England Journal published the results of the Coral Reef Lipids trial of the oral PCSK9 drug in licitide.

這項研究在 AHA 上發表，但這週才刊登出來，所以我們會簡單討論一下。

The study was presented at AHA, but it's published this week so we'll talk about it briefly.

我重新看了一下這項試驗，它真的很令人印象深刻。

And I relooked at the trial and it's impressive.

This was a BIG trial, about 3,000 patients who had an elevated LDL cholesterol, almost all of them on statins.

這是一項大型試驗，大約有 3,000 名 LDL 膽固醇偏高的病患，其中絕大多數都正在使用 statins。

And it was just enlistatide versus placebo.

而這項試驗是比較 in licitide 和安慰劑。

The primary endpoint of this trial was LDL cholesterol lowering, not cardiovascular outcomes.

這項試驗的主要終點是降低 LDL 膽固醇，而不是心血管預後。

Inlicitide worked, resulted in a about 55% reduction place placebo resistant reduction in LDL cholesterol over the 52 week trial.

in licitide 確實有效，在為期 52 週的試驗中，與安慰劑相比，LDL 膽固醇降低了約 55%。

There were no safety signals compared to placebo.

與安慰劑相比，沒有出現任何安全訊號。

And so my comments, this may be my briefest commentary on a trial ever because this seems like a clear winner.

所以我的評論，這可能是我對試驗最簡短的評論了，因為這似乎是一個明顯的贏家。

The drug shreds non HDL cholesterol and it's on top of statins.

這款藥物能顯著降低非 HDL 膽固醇，而且是在 statins 基礎上使用的。

The degree of reduction is similar to the injectable PCSK9 drugs.

降低的幅度與注射型 PCSK9 藥物相似。

And it's more than bempedoic acid, more than ezetimibe and more than inclisiran.

而且比 bempedoic acid、ezetimibe 和 inclisiran 都還要好。

And a daily pill is always gonna be better than a weekly injection.

而口服藥丸總是比每週注射來得方便。

So I can't see how this drug doesn't help patients though.

所以我實在想不到這款藥物怎麼會對病患沒有幫助。

We need to remember this wasn't an outcomes trial.

我們要記得這不是一個結果試驗。

The LDL cholesterol is still a surrogate.

LDL 膽固醇仍然是一個替代指標。

It happens to be a very reliable surrogate for ascvd, but it's still a surrogate.

雖然它碰巧是一個非常可靠的 ascvd 替代指標，但它仍然是替代指標。

The authors tell us in the paper that Merck is sponsoring a large outcome trial called Coral Reef Outcomes Trial with a projected completion date of December of 2029.

作者在論文中告訴我們，Merck 正在贊助一項名為 Coral Reef Outcomes Trial 的大型結果試驗，預計於 2029 年 12 月完成。

And of course another major headwind for this drug in the US will be cost because you can be sure that Merck will price the drug quite high.

當然，這款藥物在美國的另一個主要逆風就是成本，因為你可以肯定 Merck 會將藥物定價相當高。

All right, speaking of wins, the next topic is a win for Factor 11 inhibitor, Ascendexian.

好了，說到贏家，下一個話題是 Factor 11 抑制劑 Ascendexian 的勝利。

Now, a couple of years ago, the promise of Factor 11 inhibition as a safer oral anticoagulant took a huge hit when the Oceanic Afib study of Ascendexian versus Apixaban in patients with AF had to be stopped early because of higher stroke rates in the Factor 11 arm.

不過，幾年前，Factor 11 抑制作為一種更安全的口服抗凝劑的希望，在 Oceanic Afib 研究中，Ascendexian 與 Apixaban 在心房顫動患者中的比較，因為 Factor 11 組的中風發生率較高而必須提前終止，受到了重創。

The Factor 11 drug just didn't seem to have the anticoagulant efficacy that apixaban had at the time.

當時，Factor 11 藥物似乎沒有像 Apixaban 那樣的抗凝療效。

In November of 23 the decision was made to continue the Oceanic Stroke Study of a seduction 50mg daily versus placebo in patients with non cardioembolic stroke or high risk tia.

在 23 年 11 月，決定繼續進行 Oceanic Stroke Study，讓 seduction 50mg 每日一次與安慰劑比較，用於非心源性中風或高風險短暫性腦缺血發作的患者。

These are the type of stroke patients plan for antiplatelet therapy either with single or dual antiplatelet therapy.

這些是計畫接受單一或雙重抗血小板治療的這類中風患者。

Oceanic Stroke had a primary endpoint of ischemic stroke at a primary safety endpoint of bleeding oh, along with many secondary endpoints.

Oceanic Stroke 的主要終點是缺血性中風，主要安全終點是出血，此外還有許多次要終點。

The trial results were just presented in New Orleans at the Stroke Congress.

試驗結果剛在紐奧良的中風大會上發表。

I don't think there's a paper yet, but I did find the slide deck thanks to Dr.

我認為還沒有論文，但我感謝 Dr.

Mike Gibson on X and I've attached that link in the show notes so you'll be able to see the slides.

Mike Gibson 在 X 上提供的投影片，我已將連結附在節目筆記中，大家可以看看這些投影片。

The inclusion Criteria were adults within 72 hours of symptom onset.

納入標準是症狀發作後 72 小時內的成人。

This was felt to be non cardioembolic ischemic stroke with a NIH SS less than or equal to 15 or high risk TIA.

這被認為是非心源性缺血性中風，NIH SS 小於或等於 15 或高風險 TIA。

These patients had a history of atherosclerosis or evidence of plaque on imaging or non lacunar stroke on imaging.

這些病患有動脈粥狀硬化病史，或影像學顯示有斑塊，或影像學顯示非腔隙性中風。

They had a plan for antiplatelet therapy, single or dual.

他們有單一或雙重抗血小板治療的計畫。

Now of course if the patient had AFIB or another source of cardioemboli, they were not included in this study.

當然，如果病患有心房顫動或其他心源性栓塞的來源，他們就不會被納入這項研究。

This was a huge trial of over 6,000 patients per arm.

這是一項規模龐大的試驗，每組超過 6,000 名病患。

Most of these patients had cardiovascular disease or substantial cardiovascular risk factors.

這些病患大多數都有心血管疾病或顯著的心血管危險因子。

Just under a third had interventional therapy with either endovascular or thrombolytic therapy for their acute stroke event.

不到三分之一的病患在急性中風事件中接受了血管內治療或血栓溶解治療。

About 2/3 of the patients were on dual antiplatelet therapy.

大約三分之二的病患接受雙重抗血小板治療。

The main Result was a 26% reduction in recurrent ischemic stroke over three years.

主要結果是三年內復發性缺血性中風減少了 26%。

26% reduction hazard ratio 0.74 95% conference interval 0.65 to 0.84 absolute risk reduction numbers.

減少 26% 的風險比 0.74，95% 信賴區間 0.65 至 0.84，絕對風險減少數字。

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2026年2月6日心臟學週報！ (Feb 06 2026 This Week in Cardiology)

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2026年2月6日 心臟學週報！ (Feb 06 2026 This Week in Cardiology)

positive

therapy

instance

treat

2026年2月6日心臟學週報！ (Feb 06 2026 This Week in Cardiology)