Application of a Lifestyle-Based Tool to Estimate Premature Cardiovascular Disease Events in Young Adults The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Application of a Lifestyle-Based Tool to Estimate Premature Cardiovascular Disease Events in Young Adults The Coronary Artery Risk Development in Young Adults (CARDIA) Study
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DOI：
10.1001/jamainternmed.2017.2922
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发表时间：
2017-09-01
影响因子：
39
通讯作者：
Chiuve, Stephanie
中科院分区：
文献类型：
--
作者：
Gooding, Holly C.;Ning, Hongyan;Chiuve, Stephanie
研究目的：评估健康心脏评分（HHS）对55岁以前发生的ASCVD事件的评估效果。这项前瞻性队列研究包括4893名来自年轻人冠状动脉风险发展（CARDIA）研究的18至30岁的美国成年人。参与者从1985年3月25日到1986年6月7日接受了生活方式因素的测量，并随访了中位数为27.1年（四分位数范围，26.9-27.2年）。这项研究的数据分析时间为2016年2月24日至12月12日。暴露HHS包括年龄、吸烟状况、体重指数、酒精摄入量、运动和饮食评分，饮食评分由自我报告的每日谷物纤维摄入量、水果和/或蔬菜、坚果、含糖饮料以及红色和/或加工肉类组成。心脏研究中的HHS是使用其衍生cohols.Main结局和测量的性别特异性方程计算的。HHS评估总样本、种族和性别特异性亚组、基线时有和无临床ASCVD风险因素的人群中ASCVD（冠心病死亡、非致死性心肌梗死和致死性或非致死性缺血性卒中）25年风险的能力。模型辨别力用Harrell C统计量进行评估;模型校准用Greenwood-Nam-D 'Agostino统计量进行评估。（45.1%）和2 688名妇女（54.9%），基线时平均（SD）年龄为24.8岁2483例（50.7%）为黑人; 427例（8.7%）至少有1个临床ASCVD风险因素（高血压、高脂血症或1型和2型糖尿病）。在这些参与者中，64例过早ASCVD事件发生在女性和99例男性中。HHS在大多数健康年轻人的多样化人群中显示出对ASCVD风险评估的中度歧视（C统计量，0.71; 95% CI，0.66-0.76）;在男性中表现更好（C统计量，0.74; 95% CI，0.68-0.79）（C统计量，0.69; 95% CI，0.62-0.75）;白色（C统计量，0.77; 95% CI，0.71-0.84）（C统计量，0.66; 95% CI，0.60-0.72）参与者;而在那些没有（C统计量，0.71; 95% CI，0.66-0.76）vs（C统计量，0.64; 95% CI，0.55-0.73）基线临床风险因素。HHS在总体上和每个亚组内进行了充分校准。结论和相关性当在没有ASCVD风险因素的年轻人中进行测量时，HHS在评估中年早期ASCVD事件风险方面表现良好。它依赖于自我报告的，可改变的生活方式因素，使其成为风险评估和早期ASCVD预防咨询的有吸引力的工具。
IMPORTANCE Few tools exist for assessing the risk for early atherosclerotic cardiovascular disease (ASCVD) events in young adults.OBJECTIVE To assess the performance of the Healthy Heart Score (HHS), a lifestyle-based tool that estimates ASCVD events in older adults, for ASCVD events occurring before 55 years of age.DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included 4893 US adults aged 18 to 30 years from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants underwent measurement of lifestyle factors from March 25, 1985, through June 7, 1986, and were followed up for a median of 27.1 years (interquartile range, 26.9-27.2 years). Data for this study were analyzed from February 24 through December 12, 2016.EXPOSURES The HHS includes age, smoking status, body mass index, alcohol intake, exercise, and a diet score composed of self-reported daily intake of cereal fiber, fruits and/or vegetables, nuts, sugar-sweetened beverages, and red and/or processed meats. The HHS in the CARDIA studywas calculated using sex-specific equations produced by its derivation cohorts.MAIN OUTCOMES AND MEASURES The ability of the HHS to assess the 25-year risk for ASCVD (death from coronary heart disease, nonfatalmyocardial infarction, and fatal or nonfatal ischemic stroke) in the total sample, in race-and sex-specific subgroups, and in those with and without clinical ASCVD risk factors at baseline. Model discrimination was assessed with the Harrell C statistic; model calibration, with Greenwood-Nam-D'Agostino statistics.RESULTS The study population of 4893 participants included 2205 men (45.1%) and 2688 women (54.9%) with a mean (SD) age at baseline of 24.8 (3.6) years; 2483 (50.7%) were black; and 427 (8.7%) had at least 1 clinical ASCVD risk factor (hypertension, hyperlipidemia, or diabetes types 1 and 2). Among these participants, 64 premature ASCVD events occurred in women and 99 in men. The HHS showed moderate discrimination for ASCVD risk assessment in this diverse population of mostly healthy young adults (C statistic, 0.71; 95% CI, 0.66-0.76); it performed better in men (C statistic, 0.74; 95% CI, 0.68-0.79) than in women (C statistic, 0.69; 95% CI, 0.62-0.75); in white (C statistic, 0.77; 95% CI, 0.71-0.84) than in black (C statistic, 0.66; 95% CI, 0.60-0.72) participants; and in those without (C statistic, 0.71; 95% CI, 0.66-0.76) vs with (C statistic, 0.64; 95% CI, 0.55-0.73) clinical risk factors at baseline. The HHS was adequately calibrated overall and within each subgroup.CONCLUSIONS AND RELEVANCE The HHS, when measured in younger persons without ASCVD risk factors, performs moderately well in assessing risk for ASCVD events by early middle age. Its reliance on self-reported, modifiable lifestyle factors makes it an attractive tool for risk assessment and counseling for early ASCVD prevention.