Development and Validation of Improved Algorithms for the Assessment of Global Cardiovascular Risk in Women
Development and Validation of Improved Algorithms for the Assessment of Global Cardiovascular Risk in Women
复制标题
女性整体心血管风险评估改进算法的开发和验证
DOI：
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
N. Cook
中科院分区：
文献类型：
--
作者：
P. Ridker;J. Buring;N. Rifai;N. Cook
在1956年至1966年的十年间，马萨诸塞州弗雷明翰的研究人员将年龄、高血压、吸烟、糖尿病和高脂血症定义为冠心病的主要决定因素，并创造了冠心病危险因素一词。随着时间的推移，这些标记物被编码到全球风险评分中，用于评估心血管风险。然而，对于女性来说，高达20%的所有冠状动脉事件发生在没有这些主要危险因素的情况下，而许多具有传统危险因素的女性没有经历过冠状动脉事件。此外，在过去的半个世纪里，对动脉粥样硬化血栓形成的生物学过程的理解已经明显转变，包括止血、血栓形成、炎症、内皮功能障碍和斑块不稳定等复杂生物学。尽管对病理生理学的看法发生了变化，但目前针对女性的风险算法中包含的变量与40年前推荐的变量相比基本没有变化。已提出的其他风险标记物包括替代的血脂指标，如载脂蛋白A-I和B-100、非高密度脂蛋白胆固醇(HDL-C)和脂蛋白(A)；炎症生物标记物，如高敏C反应蛋白(HsCRP)、可溶性细胞间黏附分子1(sICAM-1)和纤维蛋白原；血糖控制标记物，如糖化血红蛋白A1c；以及血浆肌氨酸和同型半胱氨酸水平。然而，评估是否可以开发出使用这些标记的改进的风险预测算法的数据很少。我们分析了所有这些新的生物标记物以及大量的传统生物标记物，编辑评论见第641页。作者所在机构：唐纳德·W·雷诺兹心血管研究中心和心血管疾病预防中心(DRS Ridker、库克和布林)、预防医学部(DRS Ridker、布灵和库克)、心血管病科(Ridker博士)、马萨诸塞州波士顿布里格姆妇女医院和马萨诸塞州波士顿儿童医院实验室医学部(Rifai博士)。通讯作者：Paul M Ridker，医学博士，公共卫生硕士，布里格姆和妇女医院心血管疾病预防中心，900 Federal Ave，Boston，MA 02215，电子邮件：pridker@partners.org。背景尽管对动脉粥样硬化血栓形成的了解有所改善，但女性心血管预测算法在很大程度上依赖于传统的危险因素。
IN THE DECADE BETWEEN 1956 AND 1966, investigators in Framingham, Mass, defined age, hypertension, smoking, diabetes, and hyperlipidemia as major determinants of coronary heart disease and coined the term coronary risk factors. Over time, these markers were codified into global risk scores for assessment of cardiovascular risk. However, for women, up to 20% of all coronary events occur in the absence of these major risk factors, whereas many women with traditional risk factors do not experience coronary events. Furthermore, over the past halfcentury, understanding of the biological processes underlying atherothrombosis has markedly shifted to encompass the complex biology of hemostasis, thrombosis, inflammation, endothelial dysfunction, and plaque instability. Despite this changing view of pathophysiology, variables included in currentriskalgorithmsforwomenarelargely unchanged fromthose recommended40 years ago. Additional risk markers that have been proposed include alternative lipid measures, such as apolipoproteins A-I and B-100, non–high-density lipoprotein cholesterol (HDL-C), and lipoprotein(a); inflammatory biomarkers such as high-sensitivity C-reactive protein (hsCRP), soluble intercellular adhesion molecule 1 (sICAM-1), and fibrinogen; markers of glycemic control such as glycatedhemoglobinA1c; andplasmacreatinine and homocysteine levels. However, data are scant evaluating whether improved risk prediction algorithms can be developed that use these markers. We assayed all of these novel biomarkers as well as a large number of tradiFor editorial comment see p 641. Author Affiliations: Donald W. Reynolds Center for Cardiovascular Research and the Center for Cardiovascular Disease Prevention (Drs Ridker, Cook, and Buring), Division of Preventive Medicine (Drs Ridker, Buring, and Cook), and the Division of Cardiovascular Diseases (Dr Ridker), Brigham and Women’s Hospital, Boston, Mass, and the Department of Laboratory Medicine, Children’s Hospital, Boston, Mass (Dr Rifai). Corresponding Author: Paul M Ridker, MD, MPH, Center for Cardiovascular Disease Prevention, Brigham and Women’s Hospital, 900 Commonwealth Ave E, Boston, MA 02215 (pridker@partners.org). Context Despite improved understanding of atherothrombosis, cardiovascular prediction algorithms for women have largely relied on traditional risk factors.
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影响因子：
5
作者：
WILLETT, W;STAMPFER, MJ;HENNEKENS, CH
通讯作者：
HENNEKENS, CH
影响因子：
37.8
作者：
Wilson, PWF;D'Agostino, RB;Kannel, WB
通讯作者：
Kannel, WB
影响因子：
120.7
作者：
Danik, Jacqueline Suk;Rifai, Nader;Ridker, Paul M.
通讯作者：
Ridker, Paul M.
影响因子：
120.7
作者：
Mora, S;Lee, IM;Ridker, PM
通讯作者：
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影响因子：
158.5
作者：
Wang, Thomas J.;Gona, Philimon;Vasan, Ramachandran S.
通讯作者：
Vasan, Ramachandran S.