Comparison of novel risk markers for improvement in cardiovascular risk assessment in intermediate-risk individuals.
Comparison of novel risk markers for improvement in cardiovascular risk assessment in intermediate-risk individuals.
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DOI：
10.1001/jama.2012.9624
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发表时间：
2012-08-22
影响因子：
120.7
通讯作者：
Herrington, David M.
中科院分区：
文献类型：
--
作者：
Yeboah, Joseph;McClelland, Robyn L.;Polonsky, Tamar S.;Burke, Gregory L.;Sibley, Christopher T.;O'Leary, Daniel;Carr, Jeffery J.;Goff, David C., Jr.;Greenland, Philip;Herrington, David M.
据报道，冠状动脉钙化 (CAC)、颈动脉内膜中层厚度 (CIMT)、踝臂指数 (ABI)、肱动脉血流介导扩张 (FMD)、高敏 C 反应蛋白 (hs-CRP) 和冠心病 (CHD) 家族史 (FH) 等风险标志物可改善 Framingham 风险评分 (FRS) 的预测 冠心病。然而，在单个队列中没有直接比较这些标记物的风险预测。我们在动脉粥样硬化多种族研究 (MESA) 中比较了中等风险参与者 (5% < FRS < 20%) 中这 6 种风险标志物对发生 CHD/心血管疾病 (CVD) 的预测的改善情况。来自美国 6 个现场中心的 6814 名 MESA 参与者中，有 1330 名属于中度风险，没有糖尿病，并且拥有所有 6 种标志物的完整数据。招聘时间为2000年7月至2002年9月；随访期延长至 2011 年 5 月。概率加权 Cox 比例风险模型用于估计风险比 (HR)。接受者操作特征曲线下面积 (AUC) 和净重分类改进 (NRI) 用于比较添加到 FRS + 种族/民族时每个标记的增量贡献。突发冠心病定义为心梗、心绞痛、随后进行血运重建、心脏骤停复苏或冠心病死亡。 CVD 事件还包括中风或 CVD 死亡。中位随访 7.6 年（IQR 7.3 – 7.8 年）后，发生了 94 例 CHD 和 123 例 CVD 事件。在多变量分析中，CAC、ABI、hs-CRP和FH与CHD事件独立相关[HR（95%CI：分别为2.60（1.94-3.50）、0.79（0.66-0.95）、1.28（1.00-1.64）和2.18（1.38-3.42）]。CIMT和FMD与CHD事件无关多变量分析 [HR (95%CI)分别为1.17(0.95-1.45)和0.95(0.78−1.14)]。尽管单独向 FRS + 种族/民族添加标记可改善 AUC，但 CAC 提供的增量最高（0.623 vs. 0.784），而 FMD 提供的增量最少（0.623 vs. 0.639）。对于突发冠心病 (CHD)，NRI 与 CAC 为 0.659，FMD 0.024，ABI 0.036，CIMT 0.102，FH 0.160 和 hs-CRP 0.079。对于事件 CVD 也获得了类似的结果。 CAC、ABI、hs-CRP 和 FH 是中等风险个体中 CHD/CVD 事件的独立预测因子。与其他风险标记相比，CAC 提供卓越的区分度和风险重新分类。
Risk markers including coronary artery calcium (CAC), carotid intima-media thickness (CIMT), ankle-brachial Index (ABI), brachial flow-mediated dilation (FMD), high sensitivity C -reactive protein (hs-CRP) and family history (FH) of coronary heart disease (CHD) have been reported to improve on the Framingham risk score (FRS) for prediction of CHD. However, there are no direct comparisons of these markers for risk prediction in a single cohort. We compared improvement in prediction of incident CHD/cardiovascular disease (CVD) of these 6 risk markers within intermediate risk participants (5 % < FRS < 20%) in the Multi-Ethnic Study of Atherosclerosis (MESA). Of 6814 MESA participants from 6 US field centers, 1330 were intermediate risk, without diabetes mellitus, and had complete data on all 6 markers. Recruitment spanned July 2000 to September 2002; follow-up extended through May 2011. Probability- weighted Cox proportional hazard models were used to estimate hazard ratios (HR). Area under the receiver operator characteristic curve (AUC) and net reclassification improvement (NRI) were used to compare incremental contributions of each marker when added to the FRS + race/ethnicity. Incident CHD defined as MI, angina followed by revascularization, resuscitated cardiac arrest or CHD death. Incident CVD additionally included stroke or CVD death. After median follow-up of 7.6 years (IQR 7.3 – 7.8 years), 94 CHD and 123 CVD events occurred. CAC, ABI, hs-CRP and FH were independently associated with incident CHD in multivariable analyses [HR (95%CI: 2.60(1.94-3.50), 0.79(0.66-0.95), 1.28(1.00-1.64) and 2.18(1.38-3.42) respectively]. CIMT and FMD were not associated with incident CHD in multivariable analyses [HR (95%CI) 1.17(0.95- 1.45) and 0.95(0.78 −1.14) respectively]. Although the addition of the markers individually to the FRS +race/ethnicity improved the AUC, CAC afforded the highest increment (0.623 vs. 0.784) while FMD afforded the least [0.623 vs. 0.639]. For incident CHD, the NRI with CAC was 0.659, FMD 0.024, ABI 0.036, CIMT 0.102, FH 0.160 and hs-CRP 0.079. Similar results were obtained for incident CVD. CAC, ABI, hs-CRP and FH are independent predictors of incident CHD/CVD in intermediate risk individuals. CAC provides superior discrimination and risk reclassification compared with other risk markers.
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影响因子：
120.7
作者：
Fowkes, F. G. R.;Murray, G. D.;Butcher, I.;Heald, C. L.;Lee, R. J.;Chambless, L. E.;Folsom, A. R.;Hirsch, A. T.;Dramaix, M.;deBacker, G.;Wautrecht, J-C.;Kornitzer, M.;Newman, A. B.;Cushman, M.;Sutton-Tyrrell, K.;Lee, A. J.;Price, J. F.;d'Agostino, R. B.;Murabito, J. M.;Norman, P. E.;Jamrozik, K.;Curb, J. D.;Masaki, K. H.;Rodriquez, B. L.;Dekker, J. M.;Bouter, L. M.;Heine, R. J.;Nijpels, G.;Stehouwer, C. D. A.;Ferrucci, L.;McDermott, M. M.;Stoffers, H. E.;Hooi, J. D.;Knottnerus, J. A.;Ogren, M.;Hedblad, B.;Witteman, J. C.;Breteler, M. M. B.;Hunink, M. G. M.;Hofman, A.;Criqui, M. H.;Langer, R. D.;Fronek, A.;Hiatt, W. R.;Hamman, R.;Resnick, H. E.;Guralnik, J.;McDermott, M. M.
通讯作者：
McDermott, M. M.
影响因子：
24
作者：
Nambi, Vijay;Chambless, Lloyd;Folsom, Aaron R.;He, Max;Hu, Yijuan;Mosley, Tom;Volcik, Kelly;Boerwinkle, Eric;Ballantyne, Christie M.
通讯作者：
Ballantyne, Christie M.
影响因子：
--
作者：
Berrington de González A;Mahesh M;Kim KP;Bhargavan M;Lewis R;Mettler F;Land C
通讯作者：
Land C
影响因子：
--
作者：
Kim, Kwang Pyo;Einstein, Andrew J.;de Gonzalez, Amy Berrington
通讯作者：
de Gonzalez, Amy Berrington
影响因子：
120.7
作者：
Polonsky, Tamar S.;McClelland, Robyn L.;Jorgensen, Neal W.;Bild, Diane E.;Burke, Gregory L.;Guerci, Alan D.;Greenland, Philip
通讯作者：
Greenland, Philip