The effect of including C-reactive protein in cardiovascular risk prediction models for women
The effect of including C-reactive protein in cardiovascular risk prediction models for women
复制标题
DOI：
10.7326/0003-4819-145-1-200607040-00128
复制
发表时间：
2006-07-04
影响因子：
39.2
通讯作者：
Ridker, Paul M.
中科院分区：
文献类型：
--
作者：
Cook, Nancy R.;Buring, Julie E.;Ridker, Paul M.
背景资料：虽然高敏C反应蛋白（hsCRP）是心血管风险的独立预测因子，但纳入hsCRP的全球风险预测模型尚未开发用于临床。目的：开发和比较有和无hsCRP的全球心血管风险预测模型。设计：观察性队列研究。设置：美国女性健康专业人员。参与者：参与妇女健康研究的45岁及45岁以上的健康非糖尿病妇女，平均随访10年。（心肌梗死、中风、冠状动脉血运重建和心血管死亡）。高敏CRP对总体风险的相对贡献至少与总胆固醇、高密度脂蛋白（HDL）和低密度脂蛋白（LDL）胆固醇单独提供的贡献一样大，但低于年龄、吸烟和血压所提供的。当纳入hsCRP时，所有全球拟合指标均得到改善，基于可能性的指标显示出对包含hsCRP的模型的强烈偏好。使用10年风险类别0%至小于5%，5%至小于10%，10%至小于20%，20%或更高，风险预测在包括hsCRP的模型中更准确，特别是对于5%至20%之间的风险。在根据成人治疗组III协变量最初分类为风险为5%至10%以下和10%至20%以下的女性中，分别有21%和19%被重新分类为更准确的风险类别。虽然添加hsCRP对c统计量的影响很小，（一种模型辨别的方法）一旦考虑了年龄、吸烟和血压，其影响仍然大于总胆固醇、低密度脂蛋白或高密度脂蛋白胆固醇的影响，这表明c统计量在评估风险预测模型时可能不敏感。局限性：数据仅适用于女性。包括hsCRP在内的全球风险预测模型改善了女性的心血管风险分类，特别是那些10年风险为5%至20%的女性。在包括年龄、血压和吸烟状况的模型中，hsCRP至少与血脂指标一样提高了预测能力。
Background: While high-sensitivity C-reactive protein (hsCRP) is an independent predictor of cardiovascular risk, global risk prediction models incorporating hsCRP have not been developed for clinical use.Objective: To develop and compare global cardiovascular risk prediction models with and without hsCRP.Design: Observational cohort study.Setting: U.S. female health professionals.Participants: Initially healthy nondiabetic women age 45 years and older participating in the Women's Health Study and followed an average of 10 years.Measurements: Incident cardiovascular events (myocardial infarction, stroke, coronary revascularization, and cardiovascular death).Results: High-sensitivity CRP made a relative contribution to global risk at least as large as that provided by total, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) cholesterol individually, but less than that provided by age, smoking, and blood pressure. All global measures of fit improved when hsCRP was included, with likelihood-based measures demonstrating strong preference for models that include hsCRP. With use of 10-year risk categories of 0% to less than 5%, 5% to less than 10%, 10% to less than 20%, and 20% or greater, risk prediction was more accurate in models that included hsCRP, particularly for risk between 5% and 20%. Among women initially classified with risks of 5% to less than 10% and 10% to less than 20% according to the Adult Treatment Panel III covariables, 21% and 19%, respectively, were reclassified into more accurate risk categories. Although addition of hsCRP had minimal effect on the c-statistic (a measure of model discrimination) once age, smoking, and blood pressure were accounted for, the effect was nonetheless greater than that of total, LDL, or HDL cholesterol, suggesting that the c-statistic may be insensitive in evaluating risk prediction models.Limitations: Data were available only for women.Conclusions: A global risk prediction model that includes hsCRP improves cardiovascular risk classification in women, particularly among those with a 10-year risk of 5% to 20%. In models that include age, blood pressure, and smoking status, hsCRP improves prediction at least as much as do lipid measures.