Stroke risk in older British men: Comparing performance of stroke-specific and composite-CVD risk prediction tools.
Stroke risk in older British men: Comparing performance of stroke-specific and composite-CVD risk prediction tools.
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DOI：
10.1016/j.pmedr.2022.102098
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发表时间：
2023-02
影响因子：
2.8
通讯作者：
Wannamethee, Goya
中科院分区：
文献类型：
--
作者：
Ahmed, Ayesha;Ambler, Gareth;Pereira, Snehal M. Pinto;Lennon, Lucy;Papacosta, Olia;Whincup, Peter;Wannamethee, Goya
中风风险目前被估计为心血管疾病（CVD）复合风险的一部分。我们调查了来自中年人的复合心血管疾病风险预测工具QRISK3和合并队列方程- pce是否与中风特异性Framingham中风风险概况- fsrp和QStroke一样好，以捕捉老年人中风的真实风险。在英国区域心脏研究的男性（60-79岁）中进行了10年卒中结局的外部验证。在不同的验证样本（FSRP n = 3762, QStroke n = 3376, QRISK3 n = 2669和PCE n = 3047）中评估区分和校准，并对竞争风险进行调整。使用观察值和临床推荐的阈值检查敏感性/特异性。在2441名无心血管疾病（包括不同年龄组）的男性中，进一步比较了FSRP、QStroke和QRISK3的表现。观察到10y风险（/1000PY）范围从6.8（硬性中风）到11（中风/短暂性脑缺血发作）。各工具判别较弱，c指数为0.63 ~ 0.66。FSRP和QStroke在较高的预测概率下高估了风险。QRISK3和PCE总体上显示出合理的校准，在整个风险范围内有轻微的误估。在对非中风死亡进行调整后，表现更差了。然而，在没有心血管疾病的男性中，QRISK3显示出相对更好的卒中事件校准，即使在对竞争死亡进行调整后，包括最年长的男性。使用观察到的风险作为截断点，所有工具显示出相似的敏感性（63 - 73%）和特异性（52 - 54%）。当使用CVD预防阈值评估QRISK3和PCE时，卒中事件的敏感性为99%，假阳性率为97%，这表明可能需要重新检查现有的干预阈值，以反映与年龄相关的卒中负担。
Stroke risk is currently estimated as part of the composite risk of cardiovascular disease (CVD). We investigated if composite-CVD risk prediction tools QRISK3 and Pooled Cohort Equations-PCE, derived from middle-aged adults, are as good as stroke-specific Framingham Stroke Risk Profile-FSRP and QStroke for capturing the true risk of stroke in older adults. External validation for 10y stroke outcomes was performed in men (60-79y) of the British Regional Heart Study. Discrimination and calibration were assessed in separate validation samples (FSRP n = 3762, QStroke n = 3376, QRISK3 n = 2669 and PCE n = 3047) with/without adjustment for competing risks. Sensitivity/specificity were examined using observed and clinically recommended thresholds. Performance of FSRP, QStroke and QRISK3 was further compared head-to-head in 2441 men free of a range of CVD, including across age-groups. Observed 10y risk (/1000PY) ranged from 6.8 (hard strokes) to 11 (strokes/transient ischemic attacks). All tools discriminated weakly, C-indices 0.63–0.66. FSRP and QStroke overestimated risk at higher predicted probabilities. QRISK3 and PCE showed reasonable calibration overall with minor mis-estimations across the risk range. Performance worsened on adjusting for competing non-stroke deaths. However, in men without CVD, QRISK3 displayed relatively better calibration for stroke events, even after adjustment for competing deaths, including in oldest men. All tools displayed similar sensitivity (63–73 %) and specificity (52–54 %) using observed risks as cut-offs. When QRISK3 and PCE were evaluated using thresholds for CVD prevention, sensitivity for stroke events was 99 %, with false positive rate 97 % suggesting existing intervention thresholds may need to be re-examined to reflect age-related stroke burden.
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发表时间：
2015-11-01
影响因子：
7.6
作者：
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发表时间：
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