Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis.
Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis.
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DOI：
10.1001/jama.300.2.197
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发表时间：
2008-07-09
影响因子：
120.7
通讯作者：
McDermott, M. M.
中科院分区：
文献类型：
--
作者：
Fowkes, F. G. R.;Murray, G. D.;Butcher, I.;Heald, C. L.;Lee, R. J.;Chambless, L. E.;Folsom, A. R.;Hirsch, A. T.;Dramaix, M.;deBacker, G.;Wautrecht, J-C.;Kornitzer, M.;Newman, A. B.;Cushman, M.;Sutton-Tyrrell, K.;Lee, A. J.;Price, J. F.;d'Agostino, R. B.;Murabito, J. M.;Norman, P. E.;Jamrozik, K.;Curb, J. D.;Masaki, K. H.;Rodriquez, B. L.;Dekker, J. M.;Bouter, L. M.;Heine, R. J.;Nijpels, G.;Stehouwer, C. D. A.;Ferrucci, L.;McDermott, M. M.;Stoffers, H. E.;Hooi, J. D.;Knottnerus, J. A.;Ogren, M.;Hedblad, B.;Witteman, J. C.;Breteler, M. M. B.;Hunink, M. G. M.;Hofman, A.;Criqui, M. H.;Langer, R. D.;Fronek, A.;Hiatt, W. R.;Hamman, R.;Resnick, H. E.;Guralnik, J.;McDermott, M. M.
用于识别处于心血管疾病高风险中的健康个体的预测模型具有有限的准确性。踝臂指数低是动脉粥样硬化的一个指标，并有可能提高预测。确定踝臂指数是否提供独立于肩关节风险评分的心血管事件风险和死亡率信息，并可改善风险预测。合作者确定了相关研究。使用术语“ABI”的常用文本词结合文本词和医学主题词对MEDLINE（1950年至2008年2月）和EMBASE（1980年至2008年2月）进行检索，以捕获前瞻性队列设计。对参考文献列表和会议记录以及与专家的通信进行了审查，以确定其他已发表和未发表的研究。如果（1）受试者来自一般人群（2）基线时测量踝臂指数（3）受试者接受随访以检测总死亡率和心血管死亡率，则纳入研究。将每项选定研究中受试者的预先指定数据提取到组合数据集中，并对既往无冠心病病史的受试者进行个体参与者数据荟萃分析。纳入了16项符合入选标准的人群队列研究。在对24，955名男性和23，339名女性的480，325人年随访期间，踝臂指数的死亡风险呈倒J形分布，正常（低风险）踝臂指数为1.11至1.40。踝臂指数低（≤ 0.90）男性的10年心血管死亡率（95% CI）为18.7%（13.3%至24.1%），踝臂指数正常（1.11至1.40）男性为4.4%（3.2%至5.7%），风险比（95% CI）为4.2（3.5至5.4）。女性的相应死亡率为12.6%（6.2%至19.0%）和4.1%（2.2%至6.1%），风险比为3.5（2.4至5.1）。在调整Fragrance风险评分后，风险比仍然升高，男性为2.9（2.3至3.7），女性为3.0（2.0至4.4）。踝臂指数低（≤0.90）与10年总死亡率、心血管死亡率和主要冠状动脉事件发生率相比，约为每个Frachial分类总发生率的两倍。在使用Fragrance风险评分的心血管风险分层中纳入踝臂指数将导致风险类别的重新分类和治疗建议的修改，约19%的男性和36%的女性。踝臂指数的测量可能会提高心血管风险预测的准确性，超过Fragrance风险评分。发展和验证一个新的风险方程纳入踝臂指数是必要的。
Prediction models to identify healthy individuals at high risk of cardiovascular disease have limited accuracy. A low ankle brachial index is an indicator of atherosclerosis and has the potential to improve prediction. To determine if the ankle brachial index provides information on the risk of cardiovascular events and mortality independently of the Framingham Risk Score and can improve risk prediction. Relevant studies were identified by collaborators. A search of MEDLINE (1950 to February 2008) and EMBASE (1980 to February 2008), was conducted using common text words for the term ‘ABI’ combined with text words and Medical Subject Headings to capture prospective cohort designs. Review of reference lists and conference proceedings, and correspondence with experts was conducted to identify additional published and unpublished studies. Studies were included if (1) participants were derived from a general population (2) ankle brachial index was measured at baseline and (3) subjects were followed up to detect total and cardiovascular mortality. Pre-specified data on subjects in each selected study were extracted into a combined dataset and an individual participant data meta-analysis conducted on subjects who had no previous history of coronary heart disease. Sixteen population cohort studies fulfilling the inclusion criteria were included. During 480,325 person years of follow up of 24,955 men and 23,339 women, the risk of death by ankle brachial index had a reverse J shaped distribution with a normal (low risk) ankle brachial index of 1.11 to 1.40. The 10-year cardiovascular mortality (95% CI) in men with a low ankle brachial index (≤ 0.90) was 18.7% (13.3% to 24.1%) and with normal ankle brachial index (1.11 to 1.40) was 4.4% (3.2% to 5.7%), hazard ratio (95% CI) 4.2 (3.5 to 5.4). Corresponding mortalities in women were 12.6% (6.2% to 19.0%) and 4.1% (2.2% to 6.1%), hazard ratio 3.5 (2.4 to 5.1). The hazard ratios remained elevated on adjusting for Framingham Risk Score, 2.9 (2.3 to 3.7) for men and 3.0 (2.0 to 4.4) for women. A low ankle brachial index (≤0.90) was associated with approximately twice the 10-year total mortality, cardiovascular mortality and major coronary event rate compared with the overall rate in each Framingham category. Inclusion of the ankle brachial index in cardiovascular risk stratification using the Framingham Risk Score would result in reclassification of the risk category and modification of treatment recommendations in approximately 19% of men and 36% of women. Measurement of the ankle brachial index may improve the accuracy of cardiovascular risk prediction beyond the Framingham Risk Score. Development and validation of a new risk equation incorporating the ankle brachial index is warranted.
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影响因子：
37.8
作者：
Cushman, M;Arnold, AM;Tracy, RP
通讯作者：
Tracy, RP
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120.7
作者：
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Murray, EZ