Predictive value for the Chinese population of the Framingham CHD risk assessment tool compared with the Chinese multi-provincial cohort study
Predictive value for the Chinese population of the Framingham CHD risk assessment tool compared with the Chinese multi-provincial cohort study
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DOI：
10.1001/jama.291.21.2591
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发表时间：
2004-06-02
影响因子：
120.7
通讯作者：
Zhao, D
中科院分区：
文献类型：
--
作者：
Liu, J;Hong, YL;Zhao, D
背景弗雷明翰心脏研究帮助建立了评估冠心病(CHD)风险的工具，但弗雷明翰人群的同质性阻止了对其他人群的简单推断。重新校准Framingham功能可以使世界不同地区的Framingham工具适应当地人口。目的评估Framingham冠心病风险函数在中国人群中的直接表现和重新校准后的表现，并与中国多省队列研究(CMCS)得出的函数的表现进行比较。设计、设置和参与者CMCS队列包括30121名基线年龄在35岁到之间的中国成年人。参与者从11个省份招募，并在1992至2002年间对新的CHD事件进行了跟踪调查。弗雷明翰心脏研究的参与者是马萨诸塞州弗雷明翰的5251名美国白人居民，他们在1971年至1974年的基线年龄为30岁至74岁，并进行了12年的跟踪调查。主要结果衡量标准：比较危险因素(年龄、血压、吸烟、糖尿病、总胆固醇和高密度脂蛋白胆固醇[高密度脂蛋白胆固醇])时，以“硬”CHD(冠状动脉死亡和心肌梗死)为终点，通过CMCS功能、原始Framingham功能和重新调整的Framingham功能进行评估。结果CMCS队列分别有191个硬CHD事件和625个总死亡，而273个CHD事件和293个死亡。在大多数危险因素类别中，中国人和弗雷明翰人患CHID的相对风险相似，但有少数例外(即年龄，总胆固醇200-239 mg/dL[5.18-6.19 mmol/L]，男性高密度脂蛋白胆固醇低于35 mg/dL[0.91 mmol/L]；女性吸烟)。在CMCS队列中使用Framingham函数的区别与使用CMCS函数的相似：使用Framingham函数的男性和使用CMCS函数的女性的受试者工作特征曲线下面积分别为0.705和0.742，而使用CMCS函数的男性和女性的识别率分别为0.736和0.759。然而，最初的Framingham函数系统性地高估了CMCS队列中的绝对CHD风险。例如，在男性的第10个风险十分之一中，预测的冠心病死亡率为20%，而实际死亡率为3%。使用CMCS队列的危险因素平均值和平均CHD发病率重新校准Framingham函数显著改善了CMCS队列中Framingham函数的性能。结论原始Framingham函数高估了CMCS参与者的CHD风险。对Framingham函数的重新校准改进了估计，并证明Framingham模型在中国人中是有用的。对于尚未建立队列的地区，利用冠心病率和危险因素重新校准可能是开发适合当地实践的冠心病风险预测算法的有效方法。
Context The Framingham Heart Study helped to establish tools to assess coronary heart disease (CHD) risk, but the homogeneous nature of the Framingham population prevents simple extrapolation to other populations. Recalibration of Framingham functions could permit various regions of the world to adapt Framingham tools to local populations.Objective To evaluate the performance of the Framingham CHD risk functions, directly and after recalibration, in a large Chinese population, compared with the performance of the functions derived from the Chinese Multi-provincial Cohort Study (CMCS).Design, Setting, and Participants The CMCS cohort included 30121 Chinese adults aged 35 to 64 years at baseline. Participants were recruited from 11 provinces and were followed up for new CHD events from 1992 to 2002. Participants in the Framingham Heart Study were 5251 white US residents of Framingham, Mass, who were 30 to 74 years old at baseline in 1971 to 1974 and followed up for 12 years.Main Outcome Measures "Hard" CHD (coronary death and myocardial infarction) was used as the end point in comparisons of risk factors (age, blood pressure, smoking, diabetes, total cholesterol, and high-density lipoprotein cholesterol [HDL-C]) as evaluated by the CMCS functions, original Framingham functions, and recalibrated Framingham functions.Results The CMCS cohort had 191 hard CHD events and 625 total deaths vs 273 CHD events and 293 deaths, respectively, for Framingham. For most risk factor categories, the relative risks for CHID were similar for Chinese and Framingham participants, with a few exceptions (ie, age, total cholesterol of 200-239 mg/dL [5.18-6.19 mmol/L], and HDL-C less than 35 mg/dL [0.91 mmol/L] in men; smoking in women). The discrimination using the Framingham functions in the CMCS cohort was similar to the CMCS functions: the area under the receiver operating characteristic curve was 0.705 for men and 0.742 for women using the Framingham functions vs 0.736 for men and 0.759 for women using the CMCS functions. However, the original Framingham functions systematically overestimated the absolute CHD risk in the CMCS cohort. For example, in the 10th risk decile in men, the predicted rate of CHD death was 20% Vs an actual rate of 3%. Recalibration of the Framingham functions using the mean values of risk factors and mean CHD incidence rates of the CMCS cohort substantially improved the performance of the Framingham functions in the CMCS cohort.Conclusions The original Framingham functions overestimated the risk of CHD for CMCS participants. Recalibration of the Framingham functions improved the estimates and demonstrated that the Framingham model is useful in the Chinese population. For regions that have no established cohort, recalibration using CHD rates and risk factors may be an effective method to develop CHD risk prediction algorithms suited for local practice.