An analysis of calibration and discrimination among multiple cardiovascular risk scores in a modern multiethnic cohort.
An analysis of calibration and discrimination among multiple cardiovascular risk scores in a modern multiethnic cohort.
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DOI：
10.7326/m14-1281
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发表时间：
2015-02-17
影响因子：
39.2
通讯作者：
Blaha MJ
中科院分区：
文献类型：
--
作者：
DeFilippis AP;Young R;Carrubba CJ;McEvoy JW;Budoff MJ;Blumenthal RS;Kronmal RA;McClelland RL;Nasir K;Blaha MJ
动脉粥样硬化性心血管疾病（ASCVD）的准确风险评估对于有效平衡一级预防治疗的风险和获益至关重要。比较新的美国心脏协会（AHA）和美国心脏病学会（ACC）ASCVD风险评分与替代风险评分的校准和区分，并探讨预防性治疗是使用AHA-ACC-ASCVD评分报告的风险高估的原因。ASCVD的前瞻性流行病学研究。梅萨（动脉粥样硬化的多种族研究），一个以社区为基础的，性别平衡的，多种族的队列。4227名梅萨参与者，年龄在50至74岁之间，基线时无糖尿病。在10.2年的随访后，将AHA-ACC-ASCVD评分的观察和预期事件与梅萨中4种常用的风险评分及其各自的终点进行比较。新的AHA-ACC-ASCVD和3个旧的基于Framingham的风险评分高估了男性心血管事件37%至154%，女性8%至67%。在整个风险连续体中，都注意到了高估。相比之下，Reynolds风险评分高估了男性9%的风险，但低估了女性21%的风险。阿司匹林、降脂或抗高血压治疗和中期血运重建不能解释高估。梅萨与一级预防目标人群的可比性和梅萨中遗漏事件的可能性。在5个风险评分中，包括新的AHA-ACC-ASCVD评分在内的4个评分在无基线临床ASCVD的现代多种族队列中显示风险高估（25%至115%）。如果得到验证，过高估计ASCVD风险可能对个体患者和医疗保健系统产生重大影响。国家心肺血液研究所。
Accurate risk assessment of atherosclerotic cardiovascular disease (ASCVD) is essential to effectively balance the risks and benefits of therapy for primary prevention. To compare the calibration and discrimination of the new American Heart Association (AHA) and American College of Cardiology (ACC) ASCVD risk score with alternative risk scores and to explore preventive therapy as a cause of the reported risk overestimation using the AHA-ACC-ASCVD score. Prospective epidemiologic study of ASCVD. MESA (Multi-Ethnic Study of Atherosclerosis), a community-based, sex-balanced, multiethnic cohort. 4227 MESA participants aged 50 to 74 years and without diabetes at baseline. Observed and expected events for the AHA-ACC-ASCVD score were compared with 4 commonly used risk scores—and their respective end points—in MESA after a 10.2-year follow-up. The new AHA-ACC-ASCVD and 3 older Framingham-based risk scores overestimated cardiovascular events by 37% to 154% in men and 8% to 67% in women. Overestimation was noted throughout the continuum of risk. In contrast, the Reynolds Risk Score overestimated risk by 9% in men but underestimated risk by 21% in women. Aspirin, lipid-lowering or antihypertensive therapy, and interim revascularization did not explain the overestimation. Comparability of MESA with target populations for primary prevention and possibility of missed events in MESA. Of the 5 risk scores, 4, including the new AHA-ACC-ASCVD score, showed overestimation of risk (25% to 115%) in a modern, multiethnic cohort without baseline clinical ASCVD. If validated, overestimation of ASCVD risk may have substantial implications for individual patients and the health care system. National Heart, Lung, and Blood Institute.