Predicting lifetime risk for developing atherosclerotic cardiovascular disease in Chinese population: the China-PAR project
Predicting lifetime risk for developing atherosclerotic cardiovascular disease in Chinese population: the China-PAR project
复制标题
预测中国人群患动脉粥样硬化性心血管疾病的终生风险：China-PAR 项目
DOI：
10.1016/j.scib.2018.05.020
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发表时间：
2018-06-30
期刊：
影响因子：
18.9
通讯作者：
Lu, Xiangfeng
中科院分区：
文献类型：
--
作者：
Liu, Fangchao;Li, Jianxin;Lu, Xiangfeng
动脉粥样硬化性心血管疾病（ASCVD）的终生风险证据不足；然而，估计个人的终生风险可以对ASCVD负担进行全面评估。我们利用中国- par项目（中国ASCVD风险预测）的四个大型持续前瞻性队列，开发并验证了ASCVD终生风险预测方程。使用21320名参与者的两个队列（作为衍生队列）建立了性别特异性方程。另外两个独立队列分别有14,123和70,838名参与者用于外部验证。我们评估了模型性能的校准和判别措施。此外，我们估计了高10年风险（>= 10.0%）和/或高终生风险（>= 32.8%）导致的无ascvd年损失或超额绝对风险。在对衍生队列12.3年的随访后，确定了1048例ASCVD事件和1304例非ASCVD死亡。我们的性别特异性方程具有良好的内部验证，判别C统计量为0.776（95%可信区间[CI]: 0.757-0.794）和0.801 （95% CI: 0.778-0.825）。(2)男女分别为f 9-2 （P= 0.418）和5.6 （P= 0.777）。良好的外部验证也证明了预测率与观测率密切匹配。与低10年和低终生风险的男性相比，单独具有高10年风险、单独具有高终生风险或同时具有高10年和高终生风险的男性在35岁时发生ASCVD的时间分别提前3.0年、4.6年和8.6年。我们开发了性能良好的终生风险预测方程，该方程将有助于识别在中国实施创新临床和公共卫生干预措施后最有可能避免ASCVD负担的人群。(C) 2018中国科学出版社。由爱思唯尔、中国科学出版社联合出版。版权所有。
Evidence on the lifetime risk for atherosclerotic cardiovascular disease (ASCVD) is insufficient; yet, estimating an individual's lifetime risk allows for a comprehensive assessment of ASCVD burden. We developed and validated lifetime risk prediction equations for ASCVD using four large and ongoing prospective cohorts of Chinese, the China-PAR project (Prediction for ASCVD Risk in China). Sex-specific equations were developed using two cohorts (as the derivation cohort) of 21,320 participants. Two other independent cohorts with 14,123 and 70,838 participants were used for their external validation, respectively. We evaluated both calibration and discrimination measures for model performance. Furthermore, we estimated ASCVD-free years lost or excess absolute risk attributable to high 10-year risk (>= 10.0%) and/or high lifetime risk (>= 32.8%). After 12.3 years' follow-up of the derivation cohort, 1048 ASCVD events and 1304 non-ASCVD deaths were identified. Our sex-specific equations had good internal validation, with discriminant C statistics of 0.776 (95% confidence interval [CI]: 0.757-0.794) and 0.801 (95% CI: 0.778-0.825), and calibration ?(2) f 9-2 (P= 0.418) and 5.6 (P = 0.777) for men and women, respectively. Good external validation was also demonstrated with predicted rates closely matched to the observed ones. Compared with men having both low 10-year and low lifetime risk, men would develop ASCVD 3.0, 4.6 and 8.6 years earlier if they had high 10-year risk alone, high lifetime risk alone, or both high 10-year and high lifetime risk at the index age of 35 years, respectively. We developed well-performed lifetime risk prediction equations that will help to identify those with the greatest potential to avert ASCVD burden after implementation of innovative clinical and public health interventions in China. (C) 2018 Science China Press. Published by Elsevier B.V. and Science China Press. All rights reserved.