Prediction of 30-year risk for cardiovascular mortality by fitness and risk factor levels: the Cooper Center Longitudinal Study.
Prediction of 30-year risk for cardiovascular mortality by fitness and risk factor levels: the Cooper Center Longitudinal Study.
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通过健康和危险因素水平预测 30 年心血管死亡风险：库珀中心纵向研究。
DOI：
10.1161/circoutcomes.113.000531
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Berry,JarettD
中科院分区：
文献类型：
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作者：
Wickramasinghe,ChanakaD;Ayers,ColbyR;Das,Sandeep;deLemos,JamesA;Willis,BenjaminL;Berry,JarettD
众所周知，健康和传统的危险因素与心血管疾病(CVD)死亡之间存在着众所周知的关联，无论是在短期内(10年)还是在剩余的寿命内。然而，目前可用的短期和长期风险预测工具不包括测量的适合度。方法和结果我们纳入了库珀中心纵向研究(CCLS)的16 533名参与者，这些参与者之前没有心血管疾病。健康状况是使用Balke方案测量的。不同性别的健康水平是从Balke跑步机时间得出的，并根据年龄和性别不同的跑步机时间分为低、中、高三类。根据非心血管疾病死亡的竞争风险调整后的性别特定的30年心血管死亡风险估计使用特定原因风险模型进行估计，其中包括年龄、体重指数、收缩压、健康状况、糖尿病、总胆固醇和吸烟。在中位数28年的随访期内，有1123人死于心血管疾病。根据病因特定危险模型得出的心血管疾病死亡率的30年风险估计总体上显示出良好的校正(NAM-D‘Agostinoχ2[男性，P=0.286；女性，P=0.664]和歧视(c统计，男性0.81.[0.80-0.82]，女性0.86[0.82-0.91])。在所有风险因素层中，低适合度的存在与心血管疾病死亡的30年风险较大相关。结论适合度是30年风险预测函数中一个重要的额外协变量，可能在临床实践中用作有用的工具。
BackgroundFitness and traditional risk factors have well-known associations with cardiovascular disease (CVD) death in both short-term (10 years) and across the remaining lifespan. However, currently available short-term and long-term risk prediction tools do not incorporate measured fitness.Methods and ResultsWe included 16 533 participants from the Cooper Center Longitudinal Study (CCLS) without prior CVD. Fitness was measured using the Balke protocol. Sex-specific fitness levels were derived from the Balke treadmill times and categorized into low, intermediate, and high fit according to age- and sex-specific treadmill times. Sex-specific 30-year risk estimates for CVD death adjusted for competing risk of non-CVD death were estimated using the cause-specific hazards model and included age, body mass index, systolic blood pressure, fitness, diabetes mellitus, total cholesterol, and smoking. During a median follow-up period of 28 years, there were 1123 CVD deaths. The 30-year risk estimates for CVD mortality derived from the cause-specific hazards model demonstrated overall good calibration (Nam-D’Agostino χ2[men,P=0.286; women,P=0.664] and discrimination (cstatistic; men, 0.81 [0.80–0.82] and women, 0.86 [0.82–0.91]). Across all risk factor strata, the presence of low fitness was associated with a greater 30-year risk for CVD death.ConclusionsFitness represents an important additional covariate in 30-year risk prediction functions that may serve as a useful tool in clinical practice.