Derivation, internal validation, and recalibration of a cardiovascular risk score for Latin America and the Caribbean (Globorisk-LAC): A pooled analysis of cohort studies.
Derivation, internal validation, and recalibration of a cardiovascular risk score for Latin America and the Caribbean (Globorisk-LAC): A pooled analysis of cohort studies.
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DOI：
10.1016/j.lana.2022.100258
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发表时间：
2022-05
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通讯作者：
Cohorts Consortium of Latin America and the Caribbean (CC-LAC)
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作者：
Cohorts Consortium of Latin America and the Caribbean (CC-LAC)
风险分层是心血管疾病（CVD）预防的基石，也是实现减少CVD过早死亡全球目标的主要策略。没有基于拉丁美洲和加勒比地区（LAC）数据的心血管风险评分，目前尚不清楚基于欧洲和北美队列的风险评分在多大程度上代表了LAC人群的真实风险。我们使用来自9个前瞻性队列（21，378名参与者和1，202起事件）的汇总数据，开发了致命/非致命事件的CVD（包括冠心病和卒中）风险评分。我们开发了基于实验室的（收缩压，总胆固醇，糖尿病和吸烟）和基于办公室的（身体质量指数取代总胆固醇和糖尿病）模型。我们使用了考克斯比例风险，并保留了一部分参与者，通过估计Harrell的C统计量和校准斜率来内部验证我们的模型。基于实验室的模型的C统计量为72%（70-74%），校准斜率为0.994男性为0.934-1.055，女性为0.852（0.761-0.942）;对于基于办公室的模型，C统计量为71%（69-72%），男性校准斜率为1.028（0.980-1.076），女性为0.811（0.663-0.958）。在合并样本中，使用20%的风险阈值，基于实验室的模型的灵敏度为21.9%，特异性为94.2%。将阈值降低到10%，敏感性增加到52.3%，特异性降低到78.7%。本文开发的心血管风险评分具有足够的区分度和校准性。全球风险-拉丁美洲和加勒比比目前的全球或区域风险评分更适合拉丁美洲和加勒比。这项工作提供了一个工具，以加强在LAC基于风险的心血管预防。惠康信托（214185/Z/18/Z）
Risk stratification is a cornerstone of cardiovascular disease (CVD) prevention and a main strategy proposed to achieve global goals of reducing premature CVD deaths. There are no cardiovascular risk scores based on data from Latin America and the Caribbean (LAC) and it is unknown how well risk scores based on European and North American cohorts represent true risk among LAC populations. We developed a CVD (including coronary heart disease and stroke) risk score for fatal/non-fatal events using pooled data from 9 prospective cohorts with 21,378 participants and 1,202 events. We developed laboratory-based (systolic blood pressure, total cholesterol, diabetes, and smoking), and office-based (body mass index replaced total cholesterol and diabetes) models. We used Cox proportional hazards and held back a subset of participants to internally validate our models by estimating Harrell's C-statistic and calibration slopes. The C-statistic for the laboratory-based model was 72% (70–74%), the calibration slope was 0.994 (0.934–1.055) among men and 0.852 (0.761–0.942) among women; for the office-based model the C-statistic was 71% (69–72%) and the calibration slope was 1.028 (0.980–1.076) among men and 0.811 (0.663–0.958) among women. In the pooled sample, using a 20% risk threshold, the laboratory-based model had sensitivity of 21.9% and specificity of 94.2%. Lowering the threshold to 10% increased sensitivity to 52.3% and reduced specificity to 78.7%. The cardiovascular risk score herein developed had adequate discrimination and calibration. The Globorisk-LAC would be more appropriate for LAC than the current global or regional risk scores. This work provides a tool to strengthen risk-based cardiovascular prevention in LAC. Wellcome Trust (214185/Z/18/Z)