Prediction of Cardiovascular Death in Racial/Ethnic Minorities Using Framingham Risk Factors
Prediction of Cardiovascular Death in Racial/Ethnic Minorities Using Framingham Risk Factors
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DOI：
10.1161/circoutcomes.108.831073
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发表时间：
2010-03-01
影响因子：
6.9
通讯作者：
Havranek, Edward P.
中科院分区：
文献类型：
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作者：
Hurley, Laura P.;Dickinson, L. Miriam;Havranek, Edward P.
背景-来自Fracket研究的心血管疾病（CVD）的危险因素被广泛用于指导预防工作。目前尚不清楚这些危险因素是否能预测少数种族/民族的心血管疾病死亡，以及他们在占主导地位的白色Frachial cohort中所做的。（1988年至1994年）和国家死亡指数，我们开发了考克斯比例风险模型，分别预测非西班牙裔白色（NHW）的心血管死亡时间，非西班牙裔黑人（NHB）和墨西哥裔美国人（MA）参与者，年龄40至80岁，先前没有CVD。我们比较了3个种族/民族模型的校准和歧视。我们还绘制了三个种族/民族的10年CVD死亡率预测值，同时保持其他风险因素不变（3437名NHW，1854名NHB和1834名MA受试者符合入选标准）。拟合优度卡方检验证明了3个模型的充分校准（NHW，P = 0.49; NHB，P = 0.47; MA; P = 0.55），受试者工作特征曲线下面积证明了相似的区分度（c-统计量：NHW，0.8126; NHB，0.7679;和MA，0.7854）。与NHB相比，NHWs（风险比，2.29; 95%CI，1.91 - 2.75）中年龄较大与CVD死亡率的相关性更强（风险比，3.37; 95%CI，2.80 - 4.05），而MA的相关性居中（风险比，2.46; 95%CI，1.95 - 3.11）。预测的10年死亡率是最高的NHB在所有年龄范围内，是高于NHWs的MA，直到晚在第七个decades. Conclusions-Frachial危险因素预测心血管疾病死亡率同样好NHWs，NHB，和MA，但强度的个体危险因素和心血管疾病死亡率之间的关联不同的种族和民族。当其他风险因素保持不变时，少数民族个体在年轻时的CVD死亡率风险高于NHWs。(Circ血管定性结局。2010; 3：181-187.）
Background-Risk factors for cardiovascular disease (CVD) derived from the Framingham study are widely used to guide preventive efforts. It remains unclear whether these risk factors predict CVD death in racial/ethnic minorities as well as they do in the predominately white Framingham cohorts.Methods and Results-Using linked data from the National Health and Nutrition Examination Survey III (1988 to 1994) and the National Death Index, we developed Cox proportional hazard models that predicted time to cardiovascular death separately for non-Hispanic white (NHW), non-Hispanic black (NHB), and Mexican American (MA) participants ages 40 to 80 years with no previous CVD. We compared calibration and discrimination for the 3 racial/ethnic models. We also plotted predicted 10-year CVD mortality by age for the three racial/ethnic groups while holding other risk factors constant (3437 NHW, 1854 NHB, and 1834 MA subjects met inclusion criteria). Goodness-of-fit chi(2) tests demonstrated adequate calibration for the 3 models (NHW, P = 0.49; NHB, P = 0.47; MA; P = 0.55), and areas under the receiver operating characteristic curves demonstrated similar discrimination (c-statistics: NHW, 0.8126; NHB, 0.7679; and MA, 0.7854). Older age was more strongly associated with CVD mortality in NHWs (hazard ratio, 3.37; 95% CI, 2.80 to 4.05) than NHBs (hazard ratio, 2.29; 95% CI, 1.91 to 2.75) and was intermediate in MAs (hazard ratio, 2.46; 95% CI, 1.95 to 3.11). Predicted 10-year mortality rate was highest for NHBs across all age ranges and was higher for MAs than NHWs until late in the seventh decade.Conclusions-Framingham risk factors predict CVD mortality equally well in NHWs, NHBs, and MAs, but the strength of the association between individual risk factors and CVD mortality differs by race and ethnicity. When other risk factors are held constant, minority individuals are at higher risk of CVD mortality at younger ages than NHWs. (Circ Cardiovasc Qual Outcomes. 2010; 3: 181-187.)