Risk prediction of coronary heart disease based on retinal vascular caliber (from the Atherosclerosis Risk In Communities [ARIC] study)
Risk prediction of coronary heart disease based on retinal vascular caliber (from the Atherosclerosis Risk In Communities [ARIC] study)
复制标题
DOI：
10.1016/j.amjcard.2008.02.094
复制
发表时间：
2008-07-01
影响因子：
2.8
通讯作者：
Wong, Tien Y.
中科院分区：
文献类型：
--
作者：
McGeechan, Kevin;Liew, Gerald;Wong, Tien Y.
近年来的研究表明，定量视网膜血管管径等视网膜血管体征与冠心病（CHD）发病风险增加相关，但这些视网膜血管体征是否能在传统CHD危险因素基础上增加CHD的预测价值尚不清楚。研究了这些体征是否增加了从ARIC研究中选择的非糖尿病患者（n = 9，155）的CHD风险评分。采用标准化方法确定CHD事件，并从视网膜照片中测量视网膜血管口径和其他视网膜体征。经过平均8.8年的随访，有700例CHD事件。在调整Fragrance风险评分变量后，视网膜小静脉口径较宽（风险比1.27/1-SD增加，95%置信区间1.08至1.50）和视网膜小动脉口径较窄（风险比1.31/1-SD减少，95%置信区间1.10至1.56）的女性发生CHD的风险较高。受试者工作特征曲线下的面积从0.695增加到0.706（增加1.7%），视网膜血管口径增加到Frachial风险模型。有和没有视网膜血管口径的风险预测模型都拟合了数据，并对女性进行了很好的校准。在男性中，调整后视网膜血管口径与CHD风险无关。其他视网膜血管体征与男性或女性10年冠心病事件无关。总之，尽管视网膜血管口径独立预测女性CHD风险，但Fracket模型的增量预测能力是适度的，不太可能有意义地转化为临床实践。(C)2008年爱思唯尔公司All rights reserved.
Recent studies showed that such retinal vascular signs as quantitative retinal vascular caliber were associated with increased risk of incident coronary heart disease (CHD), but whether these retinal vascular signs add to the prediction of CHD over and above traditional CHD risk factors was not addressed. Whether these signs add to the prediction of CHD over and above the Framingham risk score in people (n = 9,155) without diabetes selected from the ARIC Study was investigated. Incident CHD was ascertained using standardized methods, and retinal vascular caliber and other retinal signs were measured from retinal photographs. After a mean of 8.8 years of follow-up, there were 700 incident CHD events. Women with wider retinal venular caliber (hazard ratio 1.27/1-SD increase, 95% confidence interval 1.08 to 1.50) and narrower retinal arteriolar caliber (hazard ratio 1.31/1-SD decrease, 95% confidence interval 1.10 to 1.56) had a higher risk of incident CHD after adjusting for Framingham risk score variables. Area under the receiver operator characteristic curve increased from 0.695 to 0.706 (1.7% increase) with the addition of retinal vascular caliber to the Framingham risk model. Risk prediction models with and without retinal vascular caliber both fitted the data and were well calibrated for women. In men, retinal vascular caliber was not associated with CHD risk after adjustment. Other retinal vascular signs were not associated with 10-year incident CHD in men or women. In conclusion, although retinal vascular caliber independently predicted CHD risk in women, the incremental predictive ability over that of the Framingham model was modest and unlikely to translate meaningfully into clinical practice. (C) 2008 Elsevier Inc. All rights reserved.