Development and Validation of Risk Prediction Models for Cardiovascular Events in Black Adults The Jackson Heart Study Cohort
Development and Validation of Risk Prediction Models for Cardiovascular Events in Black Adults The Jackson Heart Study Cohort
复制标题
DOI：
10.1001/jamacardio.2015.0300
复制
发表时间：
2016-04-01
期刊：
影响因子：
24
通讯作者：
Taylor, Herman A.
中科院分区：
文献类型：
--
作者：
Fox, Ervin R.;Samdarshi, Tandaw E.;Taylor, Herman A.
心血管风险评估是预防心血管疾病（CVD）的基本组成部分。然而，通常使用的预测模型主要或专门针对白色人群。风险评估是否在黑人成年人是不同的，在白色adults是undetermined. Extentives开发和验证风险预测模型，为心血管疾病的发病率在黑人adults，纳入标准的危险因素，生物标志物，和亚临床diseases.Design，设置，和参与者的杰克逊心脏研究（JHS），纵向社区为基础的研究，5301名黑人成年人在密西西比的杰克逊。纳入研究日期为参与者首次访视日期（2000年9月至2004年3月）至2011年12月31日。中位（第75百分位数）随访时间为9.1（9.7）年。分析日期为2013年8月至2015年5月。测量包括标准危险因素，包括年龄、性别、体重指数、收缩压和舒张压、空腹总胆固醇与高密度脂蛋白胆固醇的比值、估计肾小球滤过率、抗高血压治疗、糖尿病和吸烟;血液生物标志物;和亚临床疾病测量，包括踝臂指数，颈动脉内膜-中层厚度，主要结果和测量事件CVD事件定义为首次发生心肌梗死、冠心病死亡、充血性心力衰竭、中风、事件性心绞痛或间歇性跛行。模型性能与美国心脏病学会/美国心脏协会（ACC/AHA）CVD风险算法和根据JHS数据重新拟合的FHS风险评分（FHS）进行比较，并在社区动脉粥样硬化风险（ARIC）和多种族动脉粥样硬化研究队列中进行评估。女性2390例，占64.8%。在平均9.1年的时间里，270名参与者（166名女性）经历了首次CVD事件。标准CVD风险因素、B型利钠肽和踝臂指数的简单组合（模型6）与不含B型利钠肽和踝臂指数的模型相比产生了适度的改善（C统计量，0.79; 95%CI，0.75-0.83 [相对综合辨别力改善，0.22; 95%CI，0.15-0.30]）。然而，模型6和ACC/AHA CVD合并队列风险方程之间或模型6和FHS之间的重新分类改善没有实质性差异。在ARIC和多种族研究的动脉粥样硬化数据（C统计范围，0.70-0.77）的模型区分合理，我们的研究结果使用JHS数据在本研究中是有价值的，因为他们证实，目前的FHS和ACC/AHA风险算法在黑人个体工作得很好，并不容易改进。
IMPORTANCE Cardiovascular risk assessment is a fundamental component of prevention of cardiovascular disease (CVD). However, commonly used prediction models have been formulated in primarily or exclusively white populations. Whether risk assessment in black adults is dissimilar to that in white adults is uncertain.OBJECTIVES To develop and validate risk prediction models for CVD incidence in black adults, incorporating standard risk factors, biomarkers, and subclinical disease.DESIGN, SETTING, AND PARTICIPANTS The Jackson Heart Study (JHS), a longitudinal community-based study of 5301 black adults in Jackson, Mississippi. Inclusive study dates were the date of a participant's first visit (September 2000 to March 2004) to December 31, 2011. The median (75th percentile) follow-up was 9.1 (9.7) years. The dates of the analysis were August 2013 to May 2015. Measurements included standard risk factors, including age, sex, body mass index, systolic and diastolic blood pressure, ratio of fasting total cholesterol to high-density lipoprotein cholesterol, estimated glomerular filtration rate, antihypertensive therapy, diabetes mellitus, and smoking; blood biomarkers; and subclinical disease measures, including ankle-brachial index, carotid intimal-medial thickness, and echocardiographic left ventricular hypertrophy and systolic dysfunction.MAIN OUTCOMES AND MEASURES Incident CVD event was defined as the first occurrence of myocardial infarction, coronary heart disease death, congestive heart failure, stroke, incident angina, or intermittent claudication. Model performance was compared with the American College of Cardiology/American Heart Association (ACC/AHA) CVD risk algorithm and the Framingham Risk Score (FHS) refitted to the JHS data and evaluated in the Atherosclerosis Risk in Communities (ARIC) and Multi-Ethnic Study of Atherosclerosis cohorts.RESULTS The study cohort comprised 3689 participants with mean (SD) age at baseline was 53 (11) years, and 64.8%(n = 2390) were female. Over a median of 9.1 years, 270 participants (166 women) experienced a first CVD event. A simple combination of standard CVD risk factors, B-type natriuretic peptide, and ankle-brachial index (model 6) yielded modest improvement over a model without B-type natriuretic peptide and ankle-brachial index (C statistic, 0.79; 95% CI, 0.75-0.83 [relative integrated discrimination improvement, 0.22; 95% CI, 0.15-0.30]). However, the reclassification improvement was not substantially different between model 6 and the ACC/AHA CVD Pooled Cohort risk equations or between model 6 and the FHS. The models discriminated reasonably well in the ARIC and Multi-Ethnic Study of Atherosclerosis data (C statistic range, 0.70-0.77).CONCLUSIONS AND RELEVANCE Our findings using the JHS data in the present study are valuable because they confirm that current FHS and ACC/AHA risk algorithms work well in black individuals and are not easily improved on. A unique risk calculator for black adults may not be necessary.