Carotid intima-media thickness and presence or absence of plaque improves prediction of coronary heart disease risk: the ARIC (Atherosclerosis Risk In Communities) study.
Carotid intima-media thickness and presence or absence of plaque improves prediction of coronary heart disease risk: the ARIC (Atherosclerosis Risk In Communities) study.
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DOI：
10.1016/j.jacc.2009.11.075
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发表时间：
2010-04-13
影响因子：
24
通讯作者：
Ballantyne, Christie M.
中科院分区：
文献类型：
--
作者：
Nambi, Vijay;Chambless, Lloyd;Folsom, Aaron R.;He, Max;Hu, Yijuan;Mosley, Tom;Volcik, Kelly;Boerwinkle, Eric;Ballantyne, Christie M.
我们评估了颈动脉内膜中层厚度（C-IMT）和斑块的存在或不存在是否增加了传统的危险因素（TRF）时，冠心病（CHD）的风险预测。传统的冠心病风险预测方案需要进一步改进，因为大多数冠心病事件发生在"低"和"中"风险组。C-IMT和超声上斑块的存在与CHD相关，因此可能有助于改善CHD风险预测。所考虑的风险预测模型（总体而言，男性和女性）包括仅TRF、TRF + C-IMT、TRF+斑块和TRF + C-IMT+斑块。通过计算调整乐观的受试者工作特征曲线下面积（AUC）确定模型预测性。Cox比例风险模型用于估计每种模型的10年CHD风险，并确定重新分类的个体数量。将观察到的事件与预期事件进行比较;并计算净重新分类指数（NRI）。在13，145名合格个体（5，682名男性; 7，463名女性）中，约23%通过添加C-IMT+斑块信息进行了重新分类。总体而言，将C-IMT和斑块单独或一起添加到TRF模型中改善了AUC，对于仅TRF、TRF + C-IMT、TRF+斑块和TRF + C-IMT+斑块模型，AUC分别从0.742增加到0.750、0.751和0.755。在总体人群中，与仅TRF相比，C-IMT + TRF+斑块模型的NRI为9.9%。然而，TRF + C-IMT+斑块与TRF + C-IMT或TRF+斑块的比较仅导致各种统计学检验的不显著或中等显著变化。手稿中提供了性别特异性分析。在ARIC研究中，将斑块和C-IMT加入TRF可改善CHD风险预测。
We evaluated whether carotid intima-media thickness (C-IMT) and the presence or absence of plaque improved coronary heart disease (CHD) risk prediction when added to traditional risk factors (TRF). Traditional CHD risk prediction schemes need further improvement as the majority of the CHD events occur in the “low” and “intermediate” risk groups. C-IMT and presence of plaque on an ultrasound are associated with CHD and therefore could potentially help improve CHD risk prediction. Risk prediction models (overall, in men and women) considered included TRF-only, TRF+C-IMT, TRF+plaque, and TRF+C-IMT+ plaque. Model predictivity was determined by calculating the area under the receiver operating characteristic curve (AUC) adjusted for optimism. Cox-proportional hazards models were used to estimate 10-year CHD risk for each model, and the number of individuals reclassified determined. Observed events were compared with expected events; and, the net reclassification index (NRI) was calculated. Of 13,145 eligible individuals (5,682 men; 7,463 women), ~23% were reclassified by adding C-IMT+plaque information. Overall, the addition of C-IMT and plaque separately or together to the TRF model improved the AUC which increased from 0.742 to 0.750, 0.751 and 0.755 for the TRF-only, TRF+C-IMT, TRF+plaque and TRF+C-IMT+plaque model respectively. The C-IMT+TRF+plaque model had a NRI of 9.9% when compared to TRF-only in the overall population. However, comparison of TRF+C-IMT+plaque with TRF+C-IMT or TRF+plaque only resulted in non-significant or modestly significant changes of the various statistical tests. Sex-specific analyses are presented in the manuscript. Adding plaque and C-IMT to TRF improves CHD risk prediction in the ARIC study.
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影响因子：
2.9
作者：
Chambless, LE;Zhong, MM;Heiss, G
通讯作者：
Heiss, G
影响因子：
8.9
作者：
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DOI：
10.1016/s0735-1097(03)00358-9
发表时间：
2003-06-04
影响因子：
24
作者：
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通讯作者：
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影响因子：
37.8
作者：
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通讯作者：
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影响因子：
5
作者：
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通讯作者：
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