Development of a Risk Score for Atrial Fibrillation in Adults With Diabetes Mellitus (from the ACCORD Study)
Development of a Risk Score for Atrial Fibrillation in Adults With Diabetes Mellitus (from the ACCORD Study)
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成人糖尿病患者房颤风险评分的制定（来自 ACCORD 研究）
DOI：
10.1016/j.amjcard.2020.03.002
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发表时间：
2020
影响因子：
2.8
通讯作者：
Nathan D. Wong
中科院分区：
文献类型：
--
作者：
Ping Yang;Yanglu Zhao;Nathan D. Wong
我们的目标是开发一种新的风险评分来预测糖尿病(DM)患者5年内发生房颤的风险。我们纳入了糖尿病研究队列中的受试者，这些受试者来自控制心血管风险的行动，基线时没有房颤。在基线时收集潜在的危险因素和人口统计学预测因素，并在随访期间根据心电图确定发生房颤的事件。使用COX回归和内部验证建立了房颤事件的5年风险评分。我们研究了9,240名糖尿病受试者(男性占62%，平均年龄62.6岁)，其中1.8%(n = )在4.9年的中位随访期内发生了房颤。发生房颤的受试者更有可能是男性，白人，有更多的肥胖和较差的肾功能，但舒张压和低密度脂蛋白胆固醇较低。在危险预测模型中，年龄、性别、种族、体重指数、心力衰竭、舒张压、甘油三酯、糖化血红蛋白、糖尿病病程、血肌酐和高血压药物是重要的预测因素。哈雷尔的C统计量为0.79，内部校准良好(拟合度检验p = 为0.99，校准斜率 = 为1.01)。我们的风险模型可能有助于评估糖尿病患者未来的房颤风险。
We aimed to develop a novel risk score predicting 5-year atrial fibrillation (AF) risk for diabetes mellitus (DM) patients. We included subjects from the Action to Control Cardiovascular Risk in Diabetes study cohort without AF at baseline. Potential risk factor and demographic predictors were collected at baseline and incident AF was defined from ECG during follow-up. A 5-year risk score for incident AF was developed using Cox regression with internal validation. We studied 9,240 subjects with DM (62% male, mean age 62.6 years) of which 1.8% (n = 165) developed AF over a median follow-up of 4.9 years. Subjects developing AF were more likely male, of white ethnicity and with more obesity and poorer kidney function, but with lower diastolic blood pressure and low density-lipoprotein cholesterol. In the risk prediction model, age, gender, race, body mass index, heart failure, diastolic blood pressure, triglycerides, hemoglobin A1c, duration of DM, serum creatinine and hypertension medication were included as important predictors. The Harrell's C-statistic was 0.79 with excellent internal calibration (goodness-of-fit test p = 0.99 and calibration slope = 1.01). Our risk model may be useful for assess future AF risk in DM patients.