Prediction of coronary events in a low incidence population. Assessing accuracy of the CUORE Cohort Study prediction equation
Prediction of coronary events in a low incidence population. Assessing accuracy of the CUORE Cohort Study prediction equation
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DOI：
10.1093/ije/dyh405
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发表时间：
2005-04-01
影响因子：
7.7
通讯作者：
Giampaoli, S
中科院分区：
文献类型：
--
作者：
Ferrario, M;Chiodini, P;Giampaoli, S
背景：本文的目的是推导意大利成年男性10年冠状动脉风险预测方程，并与Framingham心脏研究（FHS）和PROCAM研究方程进行比较，评估其准确性。方法：CUORE研究是一项前瞻性固定队列研究。在1982年至1996年期间，对来自意大利北部和中南部的11个队列进行了基线调查，采用MONICA方法测量风险因素。在6865名年龄在35-69岁、基线时无冠心病（CHD）的男性样本中，在中位随访9.1年期间发生了312例首次致死性和非致死性主要冠状动脉事件。校准（10年预测风险与实际风险之间的差异）和辨别（风险函数区分高风险和低风险受试者的能力）被评估，以比较FHS、PROCAM和CUORE研究方程的准确性。结果最佳CUORE方程包括年龄、总胆固醇、收缩压、吸烟、高密度脂蛋白胆固醇、糖尿病、高血压药物治疗、冠心病家族史（ROC曲线下面积= 0.75）。该CUORE随访数据中未经校准的10年风险估计值，Framingham和PROCAM风险评分分别比Kaplan-Meier对CUORE的估计值高0.093和0.109 (P < 0.05)，表明两个方程的风险都高估了。标准的再校准技术仅提高了FHS方程的精度。PROCAM高估在高风险十分位数中表现突出。通过另一种重新校准的方法获得了更好的风险估计，但需要进行队列研究以获得适当校准的风险方程。结论CUORE项目预测方程比FHS和PROCAM方程具有更好的准确性，克服了经常报道的风险高估。
Background The aims of this paper are to derive a 10-year coronary risk predictive equation for adult Italian men, and to assess its accuracy in comparison with the Framingham Heart Study (FHS) and PROCAM study equations.Methods The CUORE study is a prospective fixed-cohort study. Eleven cohorts, from the north and the centre-south of Italy, had been investigated at baseline between 1982 and 1996, adopting MONICA methods to measure risk factors. Among this sample of 6865 men, aged 35-69 years and free of coronary heart disease (CHD) at baseline, 312 first fatal and non-fatal major coronary events occurred in 9.1 years median follow-up. Calibration, as the difference between 10-year predicted and actual risk, and discrimination, as the ability of the risk functions to separate high-risk from low-risk subjects, have been assessed to compare accuracy of the FHS, the PROCAM, and the CUORE study equations.Results The best CUORE equation includes age, total cholesterol, systolic blood pressure, cigarette smoking, HDL-cholesterol, diabetes mellitus, hypertension drug treatment, and family history of CHD (area under the ROC curve = 0.75). The uncalibrated estimates of the 10-year risk in this CUORE follow-up data were 0.093 and 0.109 higher (P < 0.05) from the Framingham and PROCAM risk scores, respectively, than the Kaplan-Meier estimate for CUORE, indicating risk overestimates for both equations. Standard recalibration techniques improved accuracy of the FHS equation only. PROCAM overestimates were prominent in the higher risk deciles. With an alternative method for recalibration better risk estimates were obtained, but a cohort study was needed to obtain a properly calibrated risk equation.Conclusions The CUORE Project predictive equation showed better accuracy of the FHS and PROCAM equations, overcoming frequently reported risk overestimates.