An assessment of incremental coronary risk prediction using C-reactive protein and other novel risk markers - The atherosclerosis risk in communities study
An assessment of incremental coronary risk prediction using C-reactive protein and other novel risk markers - The atherosclerosis risk in communities study
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DOI：
10.1001/archinte.166.13.1368
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发表时间：
2006-07-10
影响因子：
--
通讯作者：
Sharrett, A. Richey
中科院分区：
文献类型：
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作者：
Folsom, Aaron R.;Chambless, Lloyd E.;Sharrett, A. Richey
背景资料：近年来，人们对额外的，特别是新的危险因素或血液标志物（如C反应蛋白）是否可以增强现有的冠心病（CHD）预测模型产生了兴趣。通过一系列的病例队列研究，社区中的预期动脉粥样硬化风险（ARIC）该研究评估了1987-1989年随访的15792名成人中19种新风险标志物与冠心病事件的相关性。新的标志物包括炎症、内皮功能、纤维蛋白形成、纤维蛋白溶解、B族维生素和感染因子抗体的测量。受试者工作特征曲线下面积（AUC）的变化被用来评估新的危险标志物对CHD预测的额外贡献超过传统的危险因素。基本风险因素模型，其中包括传统的风险因素，（年龄、种族、性别、总胆固醇和高密度脂蛋白胆固醇水平、收缩压、抗高血压药物使用、吸烟状况和糖尿病），良好地预测CHD，如通过约0.8的AUC所证明的。C-反应蛋白水平没有显著增加AUC（AUC增加0.003），大多数其他新的风险因素也没有增加。在研究的19种标志物中，脂蛋白相关磷脂酶A（2）、维生素B-6、白细胞介素6和可溶性血栓调节蛋白增加的AUC最多（范围0.006-0.011）。结论：我们的研究结果表明，常规测量这些新的标志物不足以进行风险评估。另一方面，我们的研究结果加强了主要的，可改变的危险因素评估的效用，以确定个人的冠心病风险的预防措施。
Background: There has been interest in recent years in whether additional, and in particular novel, risk factors or blood markers, such as C-reactive protein, can enhance existing coronary heart disease (CHD) prediction models.Methods: Using a series of case-cohort studies, the prospective Atherosclerosis Risk in Communities (ARIC) Study assessed the association of 19 novel risk markers with incident CHD in 15 792 adults followed up since 1987-1989. Novel markers included measures of inflammation, endothelial function, fibrin formation, fibrinolysis, B vitamins, and antibodies to infectious agents. Change in the area under the receiver operating characteristic curve (AUC) was used to assess the additional contribution of novel risk markers to CHD prediction beyond that of traditional risk factors.Results: The basic risk factor model, which included traditional risk factors (age, race, sex, total and high-density lipoprotein cholesterol levels, systolic blood pressure, antihypertensive medication use, smoking status, and diabetes), predicted CHD well, as evidenced by an AUC of approximately 0.8. The C-reactive protein level did not add significantly to the AUC (increase in AUC of 0.003), and neither did most other novel risk factors. Of the 19 markers studied, lipoprotein-associated phospholipase A(2), vitamin B-6, interleukin 6, and soluble thrombomodulin added the most to the AUC (range, 0.006-0.011).Conclusions: Our findings suggest that routine measurement of these novel markers is not warranted for risk assessment. On the other hand, our findings reinforce the utility of major, modifiable risk factor assessment to identify individuals at risk for CHD for preventive action.