Comparisons of the Framingham and Pooled Cohort Equation Risk Scores for Detecting Subclinical Vascular Disease in Blacks Versus Whites
Comparisons of the Framingham and Pooled Cohort Equation Risk Scores for Detecting Subclinical Vascular Disease in Blacks Versus Whites
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DOI：
10.1016/j.amjcard.2017.11.031
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发表时间：
2018-03-01
影响因子：
2.8
通讯作者：
Quyyumi, Arshed A.
中科院分区：
文献类型：
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作者：
Topel, Matthew L.;Shen, Jia;Quyyumi, Arshed A.
合并队列动脉粥样硬化性心血管疾病（ASCVD）风险计算器旨在改善心血管风险估计，特别是在黑人中。尽管ASCVD风险评分能更好地预测黑人的死亡率和心血管疾病事件，但其对亚临床血管疾病指标（包括动脉僵硬度和颈动脉内膜中层厚度）的表现知之甚少。我们试图确定ASCVD风险评分是否比Fragrance风险评分更好地识别黑人的亚临床血管疾病。我们计算了1，231名无已知心血管疾病的受试者（平均年龄53岁，59%为女性，37%为黑人）的Frachial和ASCVD队列风险评分，并测量了动脉僵硬程度（通过脉搏波速度（PWV），中心脉压（CPP）和中心增强指数（CAIx）确定）和亚临床动脉粥样硬化（通过颈动脉IMT（C-IMT）确定）。与白人相比，黑人的CAIx更高，（23.9 ± 10.2 vs 22.1 ± 9.6%，p = 0.004），CPP（36.4 ± 10.5 vs 34.9 ± 9.8 mmHg，p = 0.014）、PWV（7.6 ± 1.5 vs 7.3 ± 1.3 m/s，p = 0.004）和C-IMT（0.67 ± 0.10 vs 0.65 ± 0.10 mm，p = 0.005）。在包括种族和ASCVD风险评分的多变量分析中，种族仍然是亚临床血管疾病所有指标的独立预测因素;然而，种族和ASCVD风险评分的模型显示，种族不是亚临床血管疾病的独立预测因素。总之，黑人亚临床血管疾病的发生率并不能通过Fragrance风险评分来估计。新的ASCVD风险评分更好地估计了血管功能和结构的种族差异。(C)2017爱思唯尔公司All rights reserved.
The pooled cohort Atherosclerotic Cardiovascular Disease (ASCVD) risk calculator is designed to improve cardiovascular risk estimation compared with the Framingham Risk Score, particularly in blacks. Although the ASCVD risk score better predicts mortality and incident cardiovascular disease in blacks, less is known about its performance for subclinical vascular disease measures, including arterial stiffness and carotid intima-media thickness. We sought to determine if the ASCVD risk score better identifies subclinical vascular disease in blacks compared with the Framingham risk score. We calculated both the Framingham and ASCVD cohort risk scores in 1,231 subjects (mean age 53 years, 59% female, 37% black) without known cardiovascular disease and measured the extent of arterial stiffness, as determined by pulse wave velocity (PWV), central pulse pressure (CPP), and central augmentation index (CAIx), and subclinical atherosclerosis, as determined by carotid-IMT (C-IMT). Compared with whites, blacks had higher CAIx (23.9 +/- 10.2 vs 22.1 +/- 9.6%, p = 0.004), CPP (36.4 +/- 10.5 vs 34.9 +/- 9.8 mmHg, p = 0.014), PWV (7.6 +/- 1.5 vs 7.3 +/- 1.3 m/s, p = 0.004), and C-IMT (0.67 +/- 0.10 vs 0.65 +/- 0.10 mm, p = 0.005). In a multivariable analysis including race and Framingham risk score, race remained an independent predictor of all measures of subclinical vascular disease; however, models with race and the ASCVD risk score showed that race was not an independent predictor of subclinical vascular disease. In conclusion, greater subclinical vascular disease in blacks was not estimated by the Framingham risk score. The new ASCVD risk score provided a better estimate of racial differences in vascular function and structure. (C) 2017 Elsevier Inc. All rights reserved.