Comparison of risk scores for the prediction of stroke in African Americans: Findings from the Jackson Heart Study.
Comparison of risk scores for the prediction of stroke in African Americans: Findings from the Jackson Heart Study.
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DOI：
10.1016/j.ahj.2016.04.007
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发表时间：
2016-07
影响因子：
4.8
通讯作者：
O'Brien E
中科院分区：
文献类型：
--
作者：
Foraker RE;Greiner M;Sims M;Tucker KL;Towfighi A;Bidulescu A;Shoben AB;Smith S;Talegawkar S;Blackshear C;Wang W;Hardy NC;O'Brien E
现有队列研究的证据支持使用10年心血管疾病（CVD）风险评分和美国心脏协会/美国卒中协会的心血管健康（CVH）指标预测冠心病和卒中事件。我们纳入了所有在基线研究访视（2000-2004）时具有完整评分信息且无卒中史的杰克逊心脏研究参与者（n= 4，140）。我们使用Kaplan-Meier方法计算脑卒中的累积发病率，并使用考克斯模型根据CVD风险和CVH评分估计脑卒中的风险比和95%置信区间。我们根据Harrell c指数比较了两个模型的区分度，并绘制了两个模型中每个模型的预测与观察到的卒中风险校准图。非裔美国人参与者的中位年龄为54.5岁，65%为女性。在CVD风险和CVH的恶化类别中，卒中的累积发生率增加。CVD风险每增加一个单位，卒中风险增加（1.07，1.06-1.08），而CVH每增加一个单位，卒中风险降低（0.76，0.69-0.83）。如c统计量所证明的，CVH模型的区分度低于CVD风险模型（0.59，0.55-0.64 vs 0.79，0.76-0.83）。这两个分数都与剂量-反应方式的中风事件有关;然而，CVD风险模型比CVH模型更具鉴别力。CVH评分可能仍然是首选的，因为它在广泛的患者人群和公共卫生工作中的应用简单。
Evidence from existing cohort studies support the prediction of incident coronary heart disease and stroke using 10-year cardiovascular disease (CVD) risk scores and the American Heart Association/American Stroke Association's cardiovascular health (CVH) metric. We included all Jackson Heart Study participants with complete scoring information at the baseline study visit (2000-2004) who had no history of stroke (n=4,140). We used Kaplan-Meier methods to calculate the cumulative incidence of stroke, and used Cox models to estimate hazard ratios and 95% confidence intervals for stroke according to CVD risk and CVH score. We compared the discrimination of the two models according to the Harrell c-index, and plotted predicted versus observed stroke risk calibration plots for each of the two models. The median age of the African-American participants was 54.5 years, and 65% were female. The cumulative incidence of stroke increased across worsening categories of CVD risk and CVH. A one-unit increase in CVD risk increased the hazard of stroke (1.07, 1.06-1.08), while each one-unit increase in CVH corresponded to a decreased hazard of stroke (0.76, 0.69-0.83). As evidenced by the c-statistics, the CVH model was less discriminating than the CVD risk model (0.59, 0.55-0.64 versus 0.79, 0.76-0.83). Both scores were associated with incident stroke in a dose-response fashion; however, the CVD risk model was more discriminating than the CVH model. The CVH score may still be preferable for its simplicity in application to broad patient populations and public health efforts.