Validity of cardiovascular risk prediction models in Latin America and among Hispanics in the United States of America: a systematic review
Validity of cardiovascular risk prediction models in Latin America and among Hispanics in the United States of America: a systematic review
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DOI：
10.1590/s1020-49892012000800007
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发表时间：
2012-08-01
期刊：
影响因子：
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通讯作者：
Lopez-Jimenez, Francisco
中科院分区：
文献类型：
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作者：
Cortes-Bergoderi, Mery;Thomas, Randal J.;Lopez-Jimenez, Francisco
Objective.评估预测模型的使用和有效性，以估计在拉丁美洲和西班牙裔人群在美国的心血管疾病（CVD）的风险。这是对三个数据库的系统性综述：奥维德MEDLINE（1950年1月1日-2010年4月15日）、LILACS（1988年1月1日-2010年4月15日）和EMBASE（1988年1月1日-2010年4月15日）。MeSH检索词和领域与CVD、预测规则、拉丁美洲（包括加勒比海）和美国的西班牙裔相关。数据库检索的补充通信与专家在该领域。共识别出1655篇摘要，其中5个队列共13142例受试者符合入选标准。一个墨西哥队列研究显示，根据Fragrance风险评分（FRS），冠心病（CHD）的预测/观察事件率比为1.68（95%CI，1.26-2.11）;心肌梗死事件率比为1.36（95%CI，0.90-1.83）; CHD死亡事件率比为1.21（95%CI，0.43-2.00）。在厄瓜多尔，高血压患者CVD和总死亡的预测模型的曲线下面积（AUC）为0.79（95% CI，0.72-0.86），而世界卫生组织方法的AUC为0.74（95% CI，0.67-0.82）。一项预测南美锥虫病患者死亡风险的研究的AUC为0.81（95% CI，0.72-0.90）。在包括西班牙裔的美国队列中，FRS高估了西班牙裔的CVD风险，AUC为0.69。美国另一项研究评估了FRS因子预测墨西哥裔美国人CVD死亡的AUC为0.78。在拉丁美洲或美国的西班牙裔人群中，关于CVD风险预测规则的证据充其量是适度的。很可能FRS在没有正确重新校准时高估了西班牙裔的CVD风险。
Objective. To assess the use and validity of prediction models to estimate the risk of cardiovascular disease (CVD) in Latin America and among Hispanic populations in the United States of America.Methods. This was a systematic review of three databases: Ovid MEDLINE (1 January 1950-15 April 2010), LILACS (1 January 1988-15 April 2010), and EMBASE (1 January 1988-15 April 2010). MeSH search terms and domains were related to CVD, prediction rules, Latin America (including the Caribbean), and Hispanics in the United States. Database searches were supplemented by correspondence with experts in the field.Results. A total of 1 655 abstracts were identified, of which five cohorts with a total of 13 142 subjects met inclusion criteria. A Mexican cohort showed that the predicted/observed event-rate ratio for coronary heart disease (CHD) according to the Framingham risk score (FRS) was 1.68 (95% CI, 1.26-2.11); incident myocardial infarction, 1.36 (95% CI, 0.90-1.83); and CHD death, 1.21 (95% CI, 0.43-2.00). In Ecuador, a prediction model for CVD and total deaths in hypertensive patients had an area under the curve (AUC) of 0.79 (95% CI, 0.72-0.86), while the World Health Organization method had an AUC of 0.74 (95% CI, 0.67-0.82). A study predicting mortality risk in people with Chagas' disease had an AUC of 0.81 (95% CI, 0.72-0.90). Among a United States cohort that included Hispanics, FRS overestimated CVD risk for Hispanics with an AUC of 0.69. Another study in the United States that assessed FRS factors predicting CVD death among Mexican-Americans had an AUC of 0.78.Conclusions. The evidence regarding CVD risk prediction rules in Latin America or among Hispanics in the United States is modest at best. It is likely that the FRS overestimates CVD risk in Hispanics when not properly recalibrated.