Comparison of the Framingham and Reynolds Risk scores for global cardiovascular risk prediction in the multiethnic Women's Health Initiative.
Comparison of the Framingham and Reynolds Risk scores for global cardiovascular risk prediction in the multiethnic Women's Health Initiative.
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DOI：
10.1161/circulationaha.111.075929
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发表时间：
2012-04-10
期刊：
影响因子：
37.8
通讯作者：
Ridker PM
中科院分区：
文献类型：
--
作者：
Cook NR;Paynter NP;Eaton CB;Manson JE;Martin LW;Robinson JG;Rossouw JE;Wassertheil-Smoller S;Ridker PM
尚未在独立验证队列中直接比较基于弗雷明汉的心血管疾病 (CVD) 风险评分和雷诺兹风险评分。我们从多种族妇女健康倡议观察队列中选择了一个病例队列样本，其中包括 1722 例重大 CVD 病例（752 例心肌梗塞、754 例缺血性中风和 216 例其他 CVD 死亡）和 1994 名既往无 CVD 女性的随机子队列。我们使用 ATP-III 评分、雷诺兹风险评分和 Framingham CVD 模型估计风险，并重新加权以反映队列频率。不同模型预测的 10 年风险差异很大，使用 ATP-III、Reynolds 和 Framingham CVD 模型的女性分别有 6%、10% 和 41% 的风险为 10% 或更高。雷诺模型的校准是足够的，但 ATP-III 和 Framingham CVD 模型分别高估了 CHD 和主要 CVD 的风险。重新校准后，雷诺模型通过更高的 c 统计量（0.765 vs. 0.757，p=0.03）、积极的净重新分类改善（NRI）（4.9%，p=0.02）和积极的综合辨别改善（IDI）（4.1%，p<0.0001）总体表现出比 ATP-III 模型更好的辨别能力，不包括糖尿病患者 （NRI=4.2%，p=0.01）、白人（NRI=4.3%，p=0.04）和黑人（NRI=11.4，p=0.13）女性。 Reynolds (NRI=12.9, p<0.0001) 和 ATP-III (NRI=5.9%, p=0.0001) 模型表现出比 Framingham CVD 模型更好的辨别力。在这个大型外部验证队列中，雷诺风险评分比基于弗雷明汉的模型得到了更好的校准。雷诺兹分数还显示，整体歧视以及黑人和白人女性的歧视有所改善。模型之间的风险估计存在很大差异，这对他汀类药物治疗具有临床意义。
Framingham-based and Reynolds risk scores for cardiovascular disease (CVD) prediction have not been directly compared in an independent validation cohort. We selected a case-cohort sample of the multi-ethnic Women’s Health Initiative Observational Cohort, comprising 1722 cases of major CVD (752 MIs, 754 ischemic strokes, and 216 other CVD deaths) and a random subcohort of 1994 women without prior CVD. We estimated risk using the ATP-III score, the Reynolds risk score, and the Framingham CVD model, reweighting to reflect cohort frequencies. Predicted 10-year risk varied widely between models, with 10% or higher risk in 6%, 10%, and 41% of women using the ATP-III, Reynolds, and Framingham CVD models, respectively. Calibration was adequate for the Reynolds model, but the ATP-III and Framingham CVD models over-estimated risk for CHD and major CVD, respectively. After recalibration, the Reynolds model demonstrated improved discrimination over the ATP-III model through a higher c-statistic (0.765 vs. 0.757, p=0.03), positive net reclassification improvement (NRI) (4.9%, p=0.02) and positive integrated discrimination improvement (IDI) (4.1%, p<0.0001) overall, excluding diabetics (NRI=4.2%, p=0.01), and in white (NRI=4.3%, p=0.04) and black (NRI=11.4, p=0.13) women. The Reynolds (NRI=12.9, p<0.0001) and ATP-III (NRI=5.9%, p=0.0001) models demonstrated better discrimination than the Framingham CVD model. The Reynolds Risk Score was better calibrated than the Framingham-based models in this large external validation cohort. The Reynolds score also showed improved discrimination overall and in black and white women. Large differences in risk estimates exist between models, with clinical implications for statin therapy.