Metabolic syndrome does not improve the prediction of 5-year cardiovascular disease and total mortality over standard risk markers. Prospective population based study.
Metabolic syndrome does not improve the prediction of 5-year cardiovascular disease and total mortality over standard risk markers. Prospective population based study.
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DOI：
10.1097/md.0000000000000212
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发表时间：
2014-12
期刊：
影响因子：
1.6
通讯作者：
Solino-Ocaña I
中科院分区：
文献类型：
--
作者：
López-Suárez A;Bascuñana-Quirell A;Beltrán-Robles M;Elvira-González J;Fernández-Palacín F;Barroso-Casamitjana E;Solino-Ocaña I
代谢综合征(MS)被广泛认为是心血管疾病(CVD)的重要危险因素。我们评估了基于MS的模型是否比Framingham的通用CVD系统(FRS)改善了对CVD和总死亡率的预测，以及MS是否比其单个组件更好。从普通人群中随机挑选的855名参与者的前瞻性队列研究。用COX比例风险模型估计危险比，选择心血管疾病和总死亡率的综合终点。FRS的性能与4个MS模型的性能进行了比较，这些模型在使用MS的单独组件以及使用MS的优化切入点方面存在差异。评估包括辨别、校准和风险重新分类的度量。在所有模型中，只有包含MS的5个优化成分的模型改进了模型拟合度(偏差10.7，P = 0.005)、区分度(接收操作曲线下的面积差0.018)和无事件参与者的风险重分类(净重分类指数5.97，P = 0.01)。在FRS模型中加入了优化的腰围，比任何其他基于MS的模型都能更好地改善性能。每个包含MS二分定义的模型都未能改善模型的拟合度、区分度和风险重新分类。MS没有在FRS上提供关于5年心血管疾病风险和总死亡率的预测信息。MS的一些单独组成部分，特别是腰围，可能会作为FRS的一部分发挥作用，前提是它们的截断点得到优化。
Metabolic syndrome (MS) is widely believed to be an important risk factor for cardiovascular disease (CVD). We assessed whether a model based on MS improved prediction of CVD and total mortality over the Framingham's general CVD system (FRS) and whether MS was better than its individual components. Prospective cohort study of 855 participants randomly selected from the general population. Cox proportional hazards models were used to estimate the hazard ratios selecting a composite endpoint of CVD and total mortality. The performance of the FRS was compared with that of 4 MS-based models that differed in their use of individual components of MS as well as in the use of optimized cut-points of MS. The assessment included metrics of discrimination, calibration, and risk reclassification. Of all the models, only the model containing the 5 optimized components of MS improved model fit (deviance 10.7, P = 0.005), discrimination (difference of areas under the receiving operating curves 0.018), and risk reclassification in participants without events (net reclassification index 5.97, P = 0.01). The addition of optimized waist circumference to the FRS model improved the performance more than any other MS-based model. Every model containing the dichotomous definition of MS failed to improve model fit, discrimination, and risk reclassification. MS did not contribute predictive information over the FRS for the 5-year risk of CVD and total mortality. Some individual components of MS, in particular waist circumference, might play a role as part of the FRS provided their cut-off points are optimized.