<International Circulation>:   Could you outline for the readers in China who can’t make it to this year’s AHA why you think multivariate risk assessment is not ideal?

  《国际循环》：由于中国还有很多读者不能亲临今年的AHA大会，您能为这些读者们概述出为什么您认为多变量的危险因素评估并非是理想的选择吗
 
    Prof.Sniderman:  It considers too short a period of time.  Atherosclerosis develops over decades and by the time people are 35 or 40 years old a lot of people have a very significant amount of disease.  That disease is going to progress over the next 10-20 years.  The multivariable model will kick in when events become common but by that time the artery is already grossly diseased， so by that time the real potential benefit is much less than starting earlier， before the artery had become a calcified mass with scar and neovascularization.  There is no returning that kind of vessel back to normal.  At that stage we can dramatically reduce the risk with treatment but the majority of the risk remains.  Reducing risk by 30-40%， 60-70% remains.  I believe that with earlier treatment we could take risks down by 80%， although I can demonstrate this yet with data.

    Sniderman教授：我认为之所以多变量的危险因素评估并不理想，是因为它所评估的时间段太短。动脉粥样硬化是经过几十年时间逐渐发展起来的疾病，等到人们在35或40岁时很多人已经有多种多样的疾病了。这些疾病将在后来的10年到20年间继续进展。当人们发生不良事件越来越多的时候，多变量模型才参与到评估中，而这时候动脉已经病变非常严重了，因此到那时真正的潜在益处已经明显少于更早期开始的时候，也就是在动脉还没有出现大量钙化和瘢痕以及新生血管形成之前的时候。没有办法把这种血管再变回正常。在这个阶段我们进行的治疗能显著地减少危险因素，但是还有更多的危险因素仍然存在。危险因素降低了30-40%，但是还有60-70%依然存在。我相信如果能更早地开始治疗我们就能把危险因素降低80%，尽管我还不能用资料显示这一观点。
 
    <International Circulation>:   Why does multivariate calculation suggest that you should wait so long?

  《国际循环》：为什么多变量计算建议我们需要等待如此长的时间？
 
    Prof.Sniderman:  Because it was only done for 10 years.  If a patient is 40 it only covers the time until they are 50.

    Sniderman教授：因为它需要10年的时间来完成。如果一位患者是40岁，覆盖的时间段只能到他们在50岁时。
 
    <International Circulation>:   So the real thing we need to do is just extend the time of the calculations.

  《国际循环》：所以我们所需要做的事情仅是延长计算的时间。
 
    Prof.Sniderman:  That is correct.  If you do that， because in our populations approximately half of the population will have a vascular event， what does prediction mean?  When every other person will have an event， what does prediction mean?  The problem is so common and the fallibility of any model so real， that when you have someone who is deviant and recognize a cause unlike the norm， then that justifies early treatment.  I’m not suggesting treating everyone when they are 35 years old， nor advocating putting drugs in drinking water.  
    Sniderman教授：这种观点是正确的。但是如果你这样做了，由于在我们的研究人群中几乎一半的人存在血管事件，那么预测又有什么意义呢？当每3个人中有一个发生血管事件，预测的意义又有多大呢？这种情况是普遍存在的并且任何模型的不可靠性都是真实存在的，因此当你发现一位患者有异常情况并找到了导致这种情况的原因，就应该早期治疗。我并不是建议在每个人35岁的时候都对他们进行治疗，更不是拥护在日常饮水中加入药物。

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