Lifestyle-based prediction model for the prevention of CVD: the Healthy Heart Score.
Lifestyle-based prediction model for the prevention of CVD: the Healthy Heart Score.
复制标题
DOI：
10.1161/jaha.114.000954
复制
发表时间：
2014-11-14
影响因子：
5.4
通讯作者：
Rimm EB
中科院分区：
文献类型：
--
作者：
Chiuve SE;Cook NR;Shay CM;Rexrode KM;Albert CM;Manson JE;Willett WC;Rimm EB
临床实践的重点是通过改变和药物治疗升高的风险因素来预防心血管（CV）疾病（CVD）。在一级预防环境中可使用基于既定风险因素的预测模型。然而，通过健康的生活方式行为或原始预防来预防风险因素的发展，对于实现最佳的全人群CV健康和最大限度地降低长期CVD风险至关重要。我们在护士健康研究中的61025名女性和卫生专业人员随访研究中的34478名男性中开发了一种基于生活方式的CVD预测模型，这些人在1986年没有慢性疾病，并且随访≤24年。1986年，通过问卷调查对生活方式因素进行了评估。在推导步骤中，我们使用贝叶斯信息准则在每个队列中随机三分之二的参与者中分别创建简约的20年风险预测模型。这些分数在每个队列中其余三分之一的参与者中得到验证。24年来，女性有3775例心血管疾病，男性有3506例。健康心脏评分包括年龄、吸烟、体重指数、运动、酒精和综合饮食评分。在验证队列中，风险评分表现出良好的区分度（Harrell C指数，0.72; 95%置信区间[CI]，0.71，0.74 [女性]; 0.77; 95% CI，0.76，0.79 [男性]）、拟合和校准，特别是在基线无高血压或高胆固醇血症的个体中。健康心脏评分可以准确识别CVD风险升高的个体，并可作为CVD原始预防的重要临床和公共卫生筛查工具。
Clinical practice focuses on the primary prevention of cardiovascular (CV) disease (CVD) through the modification and pharmacological treatment of elevated risk factors. Prediction models based on established risk factors are available for use in the primary prevention setting. However, the prevention of risk factor development through healthy lifestyle behaviors, or primordial prevention, is of paramount importance to achieve optimal population‐wide CV health and minimize long‐term CVD risk. We developed a lifestyle‐based CVD prediction model among 61 025 women in the Nurses’ Health Study and 34 478 men in the Health Professionals Follow‐up Study, who were free of chronic disease in 1986 and followed for ≤24 years. Lifestyle factors were assessed by questionnaires in 1986. In the derivation step, we used the Bayes Information Criterion to create parsimonious 20‐year risk prediction models among a random two thirds of participants in each cohort separately. The scores were validated in the remaining one third of participants in each cohort. Over 24 years, there were 3775 cases of CVD in women and 3506 cases in men. The Healthy Heart Score included age, smoking, body mass index, exercise, alcohol, and a composite diet score. In the validation cohort, the risk score demonstrated good discrimination (Harrell's C‐index, 0.72; 95% confidence interval [CI], 0.71, 0.74 [women]; 0.77; 95% CI, 0.76, 0.79 [men]), fit, and calibration, particularly among individuals without baseline hypertension or hypercholesterolemia. The Healthy Heart Score accurately identifies individuals at elevated risk for CVD and may serve as an important clinical and public health screening tool for the primordial prevention of CVD.