Derivation, validation, and evaluation of a new QRISK model to estimate lifetime risk of cardiovascular disease: cohort study using QResearch database.
Derivation, validation, and evaluation of a new QRISK model to estimate lifetime risk of cardiovascular disease: cohort study using QResearch database.
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DOI：
10.1136/bmj.c6624
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发表时间：
2010-12-09
期刊：
影响因子：
--
通讯作者：
Brindle P
中科院分区：
文献类型：
--
作者：
Hippisley-Cox J;Coupland C;Robson J;Brindle P
目的建立、验证和评价一种新的QRISK模型来评估心血管疾病的终生风险。设计前瞻性队列研究，常规收集来自一般实践的数据。在衍生队列中建立Cox比例风险模型，推导出考虑竞争风险的风险方程。验证队列的校准和鉴别措施。在英格兰和威尔士设置563个一般做法，为QResearch数据库做出贡献。1994年1月1日至2010年4月30日期间无心血管疾病且未服用他汀类药物的30 - 84岁患者：衍生数据集中有2 343 759例，验证数据集中有1 267 159例。主要结局测量心血管疾病终生风险的个体化估计，包括吸烟状况、种族、收缩压、总胆固醇比：高密度脂蛋白胆固醇、体重指数、年龄<60岁的一级亲属有冠心病家族史、汤森剥夺评分、治疗过的高血压、类风湿关节炎、慢性肾病、2型糖尿病和心房颤动。终生心血管风险的年龄-性别百分位值与使用QRISK2估计的10年风险的比较（2010）。结果在验证数据集中的所有1 267 159例患者中，第50、75、90和95百分位的终生风险值分别为31%、39%、50%和57%。在通过终生风险模型或10年风险模型分类为最高风险的10%的验证队列患者中，只有18385例（14.5%）在两种测量方法中都处于高风险。与10年QRISK2评分相比，终生风险方法确定为高风险的患者更可能是年轻、男性、少数民族，并且有早发冠心病的阳性家族史。终生风险计算器可在www.qrisk.org/lifetime/上获得。与使用10年QRISK2评分相比，终生风险评分将倾向于在更年轻的年龄识别需要干预的患者。虽然在较早的年龄进行生活方式干预可能是有利的，但65岁以下的人收效甚微，而且医疗干预一旦开始就会带来风险。需要进行研究，仔细审查这种办法的成本效益和可接受性。
Objective To develop, validate, and evaluate a new QRISK model to estimate lifetime risk of cardiovascular disease. Design Prospective cohort study with routinely collected data from general practice. Cox proportional hazards models in the derivation cohort to derive risk equations accounting for competing risks. Measures of calibration and discrimination in the validation cohort. Setting 563 general practices in England and Wales contributing to the QResearch database. Subjects Patients aged 30–84 years who were free of cardiovascular disease and not taking statins between 1 January 1994 and 30 April 2010: 2 343 759 in the derivation dataset, and 1 267 159 in the validation dataset. Main outcomes measures Individualised estimate of lifetime risk of cardiovascular disease accounting for smoking status, ethnic group, systolic blood pressure, ratio of total cholesterol:high density lipoprotein cholesterol, body mass index, family history of coronary heart disease in first degree relative aged <60 years, Townsend deprivation score, treated hypertension, rheumatoid arthritis, chronic renal disease, type 2 diabetes, and atrial fibrillation. Age-sex centile values for lifetime cardiovascular risk compared with 10 year risk estimated using QRISK2 (2010). Results Across all the 1 267 159 patients in the validation dataset, the 50th, 75th, 90th, and 95th centile values for lifetime risk were 31%, 39%, 50%, and 57% respectively. Of the 10% of patients in the validation cohort classified at highest risk with either the lifetime risk model or the 10 year risk model, only 18 385(14.5%) were at high risk on both measures. Patients identified as high risk with the lifetime risk approach were more likely to be younger, male, from ethnic minority groups, and have a positive family history of premature coronary heart disease than those identified with the 10 year QRISK2 score. The lifetime risk calculator is available at www.qrisk.org/lifetime/. Conclusions Compared with using a 10 year QRISK2 score, a lifetime risk score will tend to identify patients for intervention at a younger age. Although lifestyle interventions at an earlier age could be advantageous, there would be small gains under the age of 65, and medical interventions carry risks as soon as they are initiated. Research is needed to examine closely the cost effectiveness and acceptability of such an approach.
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影响因子：
5.7
作者：
Hippisley-Cox, Julia;Coupland, Carol
通讯作者：
Coupland, Carol
DOI：
10.1136/bmj.b4229
发表时间：
2009-11-19
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Hippisley-Cox J;Coupland C
通讯作者：
Coupland C
影响因子：
37.8
作者：
Cooney, Marie Therese;Dudina, Alexandra;Graham, Ian M.
通讯作者：
Graham, Ian M.
影响因子：
2.9
作者：
Hippisley-Cox, Julia;Coupland, Carol
通讯作者：
Coupland, Carol
影响因子：
105.7
作者：
Hippisley-Cox, Julia;Coupland, Carol;Brindle, Peter
通讯作者：
Brindle, Peter