An independent and external validation of QRISK2 cardiovascular disease risk score: a prospective open cohort study.
An independent and external validation of QRISK2 cardiovascular disease risk score: a prospective open cohort study.
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DOI：
10.1136/bmj.c2442
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发表时间：
2010-05-13
期刊：
影响因子：
--
通讯作者：
Altman DG
中科院分区：
文献类型：
--
作者：
Collins GS;Altman DG
目的评价QRISK2评分在英国独立队列患者中预测10年心血管疾病的效果，并将其与NICE版的Framingham方程和QRISK1进行比较。设计前瞻性队列研究以验证心血管风险评分。制定来自联合王国的365种做法，为健康改善网络(Thin)数据库作出贡献。研究对象1993年1月1日至2008年6月20日在全科注册的158万名患者，年龄35-74岁(940万人年)，有71例 465心血管事件。主要观察指标一般医疗记录中记录的心血管疾病(心肌梗死、心绞痛、冠心病、中风和短暂性缺血性中风)的首次诊断。结果与NICE版本的Framingham方程相比，QRISK2提供了更好的对患者10年心血管疾病风险的预测。QRISK2的分辨率和校准统计数据更好。QRISK2可以解释33%的男性和40%的女性的差异，相比之下，NICE Framingham分别为29%和34%，QRISK1分别为32%和38%。高危人群男性心血管事件发生率(每1000人年)QRISK2为27.8(95%可信区间27.4~28.2)，NICE Framingham为21.9(21.6~22.2)，QRISK1为24.8(22.8~26.9)。同样，在高危人群中，女性心血管事件发生率(每1000人年)QRISK2为24.3(23.8-24.9)，NICE Framingham为20.6(20.1-21.0)，QRISK1为21.8(18.9-24.6)。结论在识别英国心血管疾病高危人群方面，QRISK2比NICE版本的Framingham方程更准确。QRISK2和QRISK1之间的性能差异微乎其微。
Objective To evaluate the performance of the QRISK2 score for predicting 10-year cardiovascular disease in an independent UK cohort of patients from general practice records and to compare it with the NICE version of the Framingham equation and QRISK1. Design Prospective cohort study to validate a cardiovascular risk score. Setting 365 practices from United Kingdom contributing to The Health Improvement Network (THIN) database. Participants 1.58 million patients registered with a general practice between 1 January 1993 and 20 June 2008, aged 35-74 years (9.4 million person years) with 71 465 cardiovascular events. Main outcome measures First diagnosis of cardiovascular disease (myocardial infarction, angina, coronary heart disease, stroke, and transient ischaemic stroke) recorded in general practice records. Results QRISK2 offered improved prediction of a patient’s 10-year risk of cardiovascular disease over the NICE version of the Framingham equation. Discrimination and calibration statistics were better with QRISK2. QRISK2 explained 33% of the variation in men and 40% for women, compared with 29% and 34% respectively for the NICE Framingham and 32% and 38% respectively for QRISK1. The incidence rate of cardiovascular events (per 1000 person years) among men in the high risk group was 27.8 (95% CI 27.4 to 28.2) with QRISK2, 21.9 (21.6 to 22.2) with NICE Framingham, and 24.8 (22.8 to 26.9) with QRISK1. Similarly, the incidence rate of cardiovascular events (per 1000 person years) among women in the high risk group was 24.3 (23.8 to 24.9) with QRISK2, 20.6 (20.1 to 21.0) with NICE Framingham, and 21.8 (18.9 to 24.6) with QRISK1. Conclusions QRISK2 is more accurate in identifying a high risk population for cardiovascular disease in the United Kingdom than the NICE version of the Framingham equation. Differences in performance between QRISK2 and QRISK1 were marginal.
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