A cross-validation of risk-scores for coronary heart disease mortality based on data from the Glostrup Population Studies and Framingham Heart Study
A cross-validation of risk-scores for coronary heart disease mortality based on data from the Glostrup Population Studies and Framingham Heart Study
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DOI：
10.1093/ije/31.4.817
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发表时间：
2002-08-01
影响因子：
7.7
通讯作者：
Jorgensen, T
中科院分区：
文献类型：
--
作者：
Thomsen, TF;McGee, D;Jorgensen, T
背景
由于欧洲冠心病（CHD）发病率存在显著的地区差异，欧洲心脏病学会基于弗雷明汉心脏研究数据使用冠状动脉风险图表的建议可能会受到质疑。
方法
两项人群研究（格洛斯楚普人群研究，n = 4757；弗雷明汉心脏研究，n = 2562）的数据被用于检验三种不同水平的交叉验证。第一种检验水平是，使用受试者工作特征曲线下面积（AUROC），观察从一个样本得出的风险评分是否能合理地对另一个样本参与者的风险进行排序。第二种水平是比较两项研究中逻辑回归模型系数的大小；第三种水平是测试是否能根据来自另一个样本的风险函数来估计一个样本中冠心病死亡的风险水平。
结果
弗雷明汉的冠心病死亡率为每10万人年515例，格洛斯楚普为每10万人年311例。无论使用哪种风险评分，AUROC曲线都在75% - 77%之间。两项研究之间的逻辑回归系数没有显著差异。弗雷明汉风险评分显著高估了格洛斯楚普样本中的风险，而格洛斯楚普风险评分则低估了弗雷明汉样本中的风险。
结论
在丹麦人群中使用弗雷明汉风险评分会导致对冠状动脉风险的显著高估。在应用从疾病发病率不同的人群中得出的风险评分之前，最好对其有效性进行检验。
Background Due to marked regional differences in the incidence of coronary heart disease (CHD) in Europe, the recommendation by the European Society of Cardiology to use the Coronary Risk Chart based on data from the Framingham Heart Study, could be questioned.Methods Data from two population studies (The Glostrup Population Studies, n = 4757, the Framingham Heart Study, n = 2562) were used to examine three different levels of cross-validation. The first level of examination was whether a risk-score developed from one sample adequately ordered the risk of participants in the other sample, using the Area Under a Receiver Operating Characteristic (AUROC) curve. The second level compared the magnitude of coefficients in logistic models in the two studies; while the third level tested whether the level of risk of CHD death in one sample could be estimated based on a risk function from the other sample.Result Coronary heart disease mortality was 515 per 100 000 person-years in Framingham and 311 per 100 000 person-years in Glostrup. The AUROC curve was between 75% and 77% and regardless of which risk-score was used. Logistic coefficients did not differ significantly between studies. The Framingham risk-score significantly overestimated the risk in the Glostrup sample and the Glostrup risk-score underestimated in the Framingham sample.Conclusion Using this Framingham risk-score on a Danish population will lead to a significant overestimation of coronary risk. The validity of risk-scores developed from populations with different incidence of the disease should preferably be tested prior to their application.