Evaluation of the Pooled Cohort Equations for Prediction of Cardiovascular Risk in a Contemporary Prospective Cohort
Evaluation of the Pooled Cohort Equations for Prediction of Cardiovascular Risk in a Contemporary Prospective Cohort
复制标题
DOI：
10.1016/j.amjcard.2016.11.042
复制
发表时间：
2017-03-15
影响因子：
2.8
通讯作者：
Kathiresan, Sekar
中科院分区：
文献类型：
--
作者：
Emdin, Connor A.;Khera, Amit V.;Kathiresan, Sekar
大多数指南建议进行基线风险评估，以指导动脉粥样硬化性心血管疾病（ASCVD）的预防策略。美国心脏协会/美国心脏病学会合并队列方程（PCE）是评估基线风险的一种工具;然而，该工具的准确性受到质疑。我们的目的是在Biolmage研究中检查PCE的校准和区分，Biolmage研究是一项当代多种族队列的无症状成年人，于2008年至2009年在伊利诺伊州芝加哥和佛罗里达的劳德代尔堡的Humana卫生系统登记。我们的主要终点是难治性ASCVD，定义为心血管死亡、心肌梗死和卒中。共有3,635名基线时未接受降脂治疗的成年人接受了最长4.6年的随访。平均年龄为68.6岁; 2000名（55%）参与者为女性，935名患者报告为非白人（26%）。尽管在中位随访2.7年期间观察到74起ASCVD事件，但PCE预测了198起事件。观察到的事件发生率为7.9/1000参与者-年（95%置信区间[CI] 6.1至9.8），而PCE预测的发生率为21/1000参与者-年（95% CI 20.7至21.8）。这表示高估了167%（Hosmer Lemeshow卡方= 173; p
Most guidelines suggest a baseline risk assessment to guide atherosclerotic cardiovascular disease (ASCVD) prevention strategies. The American Heart Association/American College of Cardiology Pooled Cohort Equations (PCEs) is one tool to assess baseline risk; however, the accuracy of this tool has been called into question. We aimed to examine the calibration and discrimination of the PCEs in the Biolmage study, a contemporary multiethnic cohort of asymptomatic adults enrolled from 2008 to 2009 in the Humana Health System in Chicago, Illinois, and Fort Lauderdale, Florida. Our primary end point was hard ASCVD, defined as cardiovascular death, myocardial infarction, and stroke. A total of 3,635 adults who were not on lipid-lowering therapy at baseline were followed for a maximum of 4.6 years. The mean age was 68.6 years; 2000 (55%) participants were women and 935 patients reported being of non-white race (26%). Although 74 ASCVD events were observed over a median follow-up of 2.7 years, 198 events were predicted by the PCEs. The observed event rate was 7.9 per 1,000 participant-years (95% confidence interval [CI] 6.1 to 9.8), whereas the predicted rate by the PCEs was 21 per 1,000 participant-years (95% CI 20.7 to 21.8). This represents an overestimation of 167% (Hosmer Lemeshow chi-square = 173; p