Estimating modifiable coronary heart disease risk in multiple regions of the world: the INTERHEART Modifiable Risk Score
Estimating modifiable coronary heart disease risk in multiple regions of the world: the INTERHEART Modifiable Risk Score
复制标题
DOI：
10.1093/eurheartj/ehq448
复制
发表时间：
2011-03-01
影响因子：
39.3
通讯作者：
Anand, Sonia S.
中科院分区：
文献类型：
--
作者：
McGorrian, Catherine;Yusuf, Salim;Anand, Sonia S.
目的总结危险因素负荷是评估健康个体心血管风险的一种有用的方法。我们的目标是使用来自INTERHEART病例对照研究(n=19470)的可修改危险因素来推导和验证新的心肌梗死(MI)风险评分。方法和结果采用多元Logistic回归建立INTERHEART可修改风险评分(IHMRS)。使用分裂样本法进行内部验证。在一项国际前瞻性队列研究中进行了外部验证。建立了一个包含载脂蛋白、吸烟、二手烟暴露、高血压和糖尿病的风险模型。在外部队列中，添加更多可修改的危险因素并不能改善分数歧视。裂样样本验证研究显示，受试者工作特征(ROC)曲线下的面积为0.71[95%可信区间(CI)：0.70，0.72]。在一大群心血管疾病低风险人群中，IHMRS与发生MI呈正相关[MI风险增加12%(95%CI：8，16%)，得分增加1分]，并在该队列中表现出适当的区分性(ROC c-统计量0.69，95%CI：0.64，0.74)。结果在不同种族和地理区域之间是一致的。结论利用INTERHEART病例对照研究中的多种可修改的危险因素，我们开发并验证了一种适用于国际人群的简单的MI风险评分。
Aims Summating risk factor burden is a useful approach in the assessment of cardiovascular risk among apparently healthy individuals. We aimed to derive and validate a new score for myocardial infarction (MI) risk using modifiable risk factors, derived from the INTERHEART case-control study (n = 19 470).Methods and results Multiple logistic regression was used to create the INTERHEART Modifiable Risk Score (IHMRS). Internal validation was performed using split-sample methods. External validation was performed in an international prospective cohort study. A risk model including apolipoproteins, smoking, second-hand smoke exposure, hypertension, and diabetes was developed. Addition of further modifiable risk factors did not improve score discrimination in an external cohort. Split-sample validation studies showed an area under the receiver-operating characteristic (ROC) curve c-statistic of 0.71 [95% confidence interval (CI): 0.70, 0.72]. The IHMRS was positively associated with incident MI in a large cohort of people at low risk for cardiovascular disease [12% increase in MI risk (95% CI: 8, 16%) with a 1-point increase in score] and showed appropriate discrimination in this cohort (ROC c-statistic 0.69, 95% CI: 0.64, 0.74). Results were consistent across ethnic groups and geographic regions. A non-laboratory-based score is also supplied.Conclusions Using multiple modifiable risk factors from the INTERHEART case-control study, we have developed and validated a simple score for MI risk which is applicable to an international population.