你的心血管風險有多高？
看懂健檢報告上的「十年風險分數」 How High is Your Cardiovascular Risk?
Understanding the “Ten-Year Risk Score” on Your Health Report

什麼是佛萊明罕風險分數 (FRS)？心臟的氣象預報 What is the Framingham Risk Score (FRS)? The Heart’s Weather Forecast

這個分數並非憑空產生，而是源自一項從1948年就開始的「佛萊明罕心臟研究」。當時，人們普遍認為心臟病是老化的必然結果，但這項研究首次用科學證實了高血壓、高膽固醇、吸菸等「風險因子」和心臟病的直接關聯。FRS 就是這項偉大研究的實用工具，它把複雜的醫學數據，變成一個能預測未來的風險評分。 This score didn’t appear out of thin air; it originated from the “Framingham Heart Study,” which began in 1948. At the time, heart disease was widely considered an inevitable part of aging. This study was the first to scientifically prove a direct link between “risk factors” like high blood pressure, high cholesterol, and smoking, and heart disease. The FRS is a practical tool from this monumental study, turning complex medical data into a predictive risk score.

FRS算的是什麼？ What does the FRS calculate?

簡單來說，FRS 是一個演算法，它使用您的六項關鍵健康數據，來預測您在未來十年內，發生冠狀動脈心臟病（如心肌梗塞、心絞痛）的機率有多高。這些數據包括： Simply put, the FRS is an algorithm that uses six key health data points to predict your probability of developing coronary artery disease (like myocardial infarction or angina) over the next ten years. These data points include:

• 年齡：這是影響心血管最強的風險因子之一。Age: One of the strongest risk factors for cardiovascular disease.
• 性別：男性風險通常較高，但女性停經後風險會大幅增加。Gender: Men generally have a higher risk, but women’s risk increases significantly after menopause.
• 總膽固醇：越高越危險。Total Cholesterol: The higher, the more dangerous.
• 高密度脂蛋白膽固醇 (HDL-C)：俗稱「好膽固醇」，越高越好，太低則會增加風險。High-Density Lipoprotein Cholesterol (HDL-C): Known as “good cholesterol,” higher levels are better, while low levels increase risk.
• 收縮壓 (高血壓)：血壓越高，或已在服用降血壓藥，都代表風險增加。Systolic Blood Pressure (Hypertension): Higher blood pressure, or being on blood pressure medication, indicates increased risk.
• 吸菸與糖尿病史：這兩者都是非常重要的獨立風險因子，會顯著提高您的風險。Smoking and Diabetes History: These are crucial, independent risk factors that significantly raise your risk.

計算機會根據這些資料算出一個總分，再對應到一個風險百分比。一般來說，風險等級這樣劃分： A calculator uses this information to compute a total score, which corresponds to a risk percentage. Generally, the risk levels are categorized as follows:

• 低風險：十年風險 <10%Low Risk: Ten-year risk <10%
• 中度風險：十年風險 10% 至 <20%Intermediate Risk: Ten-year risk 10% to <20%
• 高風險：十年風險 ≥20%High Risk: Ten-year risk ≥20%

「心臟年齡」是什麼意思？一個更扎心的指標 What is “Heart Age”? A More Impactful Metric

這個分數在台灣準嗎？「在地化」的重要性 Is this Score Accurate in Taiwan? The Importance of “Localization”

FRS 雖然是個里程碑，但它有「先天限制」：它最初的數據主要來自美國一個市鎮的中產階級白人。大量研究證實，直接把這個模型套用在亞洲人身上時，常常會高估我們的實際風險。這可能導致不必要的藥物治療，或是錯估了真正的風險。 While the FRS is a landmark tool, it has an “inherent limitation”: its original data primarily came from middle-class white Americans in a single town. Extensive research has confirmed that applying this model directly to an Asian population often overestimates their actual risk. This can lead to unnecessary medication or a misjudgment of true risk.

台灣的秘密武器：「慢性疾病風險評估平台」 Taiwan’s Secret Weapon: The “Chronic Disease Risk Assessment Platform”

為了解決這個問題，台灣國健署與國衛院合作，運用千萬筆台灣本地的健保與健康調查數據，開發了一套專為台灣人設計的風險評估工具——「臺灣慢性病風險評估」模型（又稱「科學算病館」）。 To address this issue, Taiwan’s Health Promotion Administration (HPA) collaborated with the National Health Research Institutes (NHRI) to develop a risk assessment tool specifically for Taiwanese people, using millions of local health insurance and survey data points. This is the “Taiwan Chronic Disease Risk Assessment” model (also known as the “Scientific Disease Calculator”).

• 適用對象：35 至 70 歲的民眾。Applicable Population: People aged 35 to 70.
• 預測範圍更廣：不只預測冠心病，還能同時預測腦中風、糖尿病、高血壓等五大慢性病風險。Wider Prediction Scope: It not only predicts coronary artery disease but also the risk of five major chronic diseases, including stroke, diabetes, and hypertension.
• 結果更直觀：用紅、黃、綠燈號呈現您的風險等級，並提供個人化的健康建議。More Intuitive Results: Uses a red, yellow, and green light system to show your risk level and provides personalized health advice.

對於台灣民眾來說，使用這個本土化工具，能得到更貼近自身狀況的評估。 For Taiwanese residents, using this localized tool provides a more accurate assessment of their own health status.

除了FRS，還有哪些更厲害的偵測工具？ Beyond FRS: More Advanced Detection Tools

現代醫學不再只依賴傳統的分數，我們現在有許多「風險增強因子」(risk enhancers) 可以更精準地評估，特別是當你處於不上不下的「中度風險」時，這些工具能幫助醫生決定下一步的策略。 Modern medicine no longer relies solely on traditional scores. We now have many “risk enhancers” that allow for a more precise assessment, especially when you are in the ambiguous “intermediate risk” category. These tools can help doctors decide on the next steps.

幾項重要的進階生物標記： Key Advanced Biomarkers:

• 高敏感度C-反應蛋白 (hs-CRP)：測量你身體的「慢性發炎」指數。心血管疾病不只是油管堵塞，更像是一場血管內的慢性火災。如果指數偏高(>2 mg/L)，代表風險增加。High-Sensitivity C-Reactive Protein (hs-CRP): Measures your body’s “chronic inflammation” level. Cardiovascular disease is not just a clogged pipe; it’s more like a chronic fire within the blood vessels. If the index is high (>2 mg/L), it indicates increased risk.
• 脂蛋白(a) [Lp(a)]：一個高達90%由基因決定的風險因子，一生中相對穩定。這解釋了為何有些生活習慣健康的人仍會早發心臟病。歐美指南建議，高風險族群一生至少應檢測一次。Lipoprotein(a) [Lp(a)]: A risk factor that is up to 90% genetically determined and remains relatively stable throughout life. This explains why some people with healthy habits still develop early-onset heart disease. Western guidelines recommend that high-risk individuals should be tested at least once in their lifetime.
• 載脂蛋白B (ApoB)：傳統測的「壞膽固醇」(LDL-C) 是看膽固醇的「總重量」，但ApoB是直接計算致病顆粒的「總數量」。很多研究認為，ApoB比LDL-C更能準確反映風險，因為致病的關鍵在於有多少「子彈」（顆粒）在衝擊血管壁。Apolipoprotein B (ApoB): Traditional “bad cholesterol” (LDL-C) measures the “total weight” of cholesterol, but ApoB directly calculates the “total number” of disease-causing particles. Many studies suggest that ApoB is a more accurate reflection of risk than LDL-C, because the key to disease lies in how many “bullets” (particles) are impacting the blood vessel walls.
• 冠狀動脈鈣化指數 (CAC Score)：這是一項非侵入性的電腦斷層掃描，可以直接「親眼看見」你的冠狀動脈有沒有鈣化斑塊。CAC分數為0，代表血管非常乾淨，未來10-15年發生心血管事件的風險極低，這被稱為「零的力量」(The Power of Zero)。Coronary Artery Calcium Score (CAC Score): This is a non-invasive CT scan that allows doctors to “see with their own eyes” if there are any calcified plaques in your coronary arteries. A CAC score of 0 means the blood vessels are very clean, and the risk of a cardiovascular event in the next 10-15 years is extremely low. This is known as “The Power of Zero.”

知道風險後，我該怎麼做？ Knowing Your Risk: What to Do Next?

一個高的風險分數並非最終判決，而是一個強烈的行動號召！絕大多數風險都可以透過生活方式的改變來顯著降低。 A high risk score is not a final verdict, but a powerful call to action! The vast majority of risks can be significantly reduced through lifestyle changes.

飲食：地中海或DASH飲食 Diet: Mediterranean or DASH Diet

這兩種是全球心臟學會最推薦的飲食模式，它們的共通點是： These two are the most recommended dietary patterns by global heart associations. Their common features are:

• 大量攝取：蔬菜、水果、全穀物。High Intake: Plenty of vegetables, fruits, and whole grains.
• 優質脂肪：以特級初榨橄欖油為主要脂肪來源。Healthy Fats: Use extra virgin olive oil as the primary source of fat.
• 聰明選擇蛋白質：多吃魚、禽肉、豆類和堅果，少吃紅肉。Smart Protein Choices: Eat more fish, poultry, legumes, and nuts, and less red meat.
• 限制：嚴格限制鈉（鹽）、飽和脂肪和額外添加的糖。Limitation: Strictly limit sodium (salt), saturated fats, and added sugars.

運動：遵循美國心臟協會 (AHA) 指南 Exercise: Follow American Heart Association (AHA) Guidelines

AHA的核心建議很簡單： The core recommendations from the AHA are simple:

• 有氧運動：每週至少150分鐘「中等強度」（快走到會喘但還能說話的程度），或75分鐘「高強度」（跑步到無法輕鬆說話）的有氧運動。Aerobic Exercise: At least 150 minutes of “moderate-intensity” (walking briskly enough to breathe hard but still be able to talk) or 75 minutes of “high-intensity” (running so you cannot talk easily) aerobic exercise per week.
• 肌力訓練：每週至少2天，鍛鍊全身主要肌群。Strength Training: At least 2 days a week, training all major muscle groups.
• 核心概念：多動、少坐！任何活動都比不動好。Core Concept: Move more, sit less! Any activity is better than none.