C-reactive protein and parental history improve global cardiovascular risk prediction: the Reynolds Risk Score for men.
C-reactive protein and parental history improve global cardiovascular risk prediction: the Reynolds Risk Score for men.
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DOI：
10.1161/circulationaha.108.814251
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发表时间：
2008-11-25
期刊：
影响因子：
37.8
通讯作者：
Cook NR
中科院分区：
文献类型：
--
作者：
Ridker PM;Paynter NP;Rifai N;Gaziano JM;Cook NR
高敏 C 反应蛋白 (hsCRP) 和家族史与未来心血管事件独立相关，并已纳入女性风险预测模型（女性雷诺风险评分）。然而，目前还没有针对男性的包含这些变量的心血管风险预测算法。我们对 10,724 名最初健康的美国非糖尿病男性进行了前瞻性随访，中位期为 10.8 年，比较了两种心血管事件预测模型的全局模型拟合、区分、校准和重新分类的测试特征，一种基于年龄、血压、吸烟状况、总胆固醇和高密度脂蛋白胆固醇（传统模型），另一种基于这些风险因素以及 hsCRP 60 岁之前父母有心肌梗塞病史（男性雷诺风险评分）。研究随访期间发生了 1,294 起心血管事件。与传统模型相比，雷诺风险评分具有更好的全局拟合（似然比检验 P<0.001）、优越（较低）的贝叶斯信息准则和较大的 C 指数（P<0.001）。对于所有心血管事件的终点，男性雷诺风险评分将 17.8% [1,904/10,724] 的研究人群（以及 20.2% [1,342/6,884] 的 10 年风险为 5% 至 20% 的人群）重新分类为较高或较低风险类别，重新分类的准确性显着提高。对于该模型比较，净重分类指数 (NRI) 为 5.3%，临床净重分类指数 (CNRI) 为 14.2%（P 值均<0.001）。在基于 ATP-III 冠心病首选终点且仅限于未采取降脂治疗的男性的模型中，16.7% 的研究人群（以及 20.1% 10 年风险为 5% 至 20% 的人群）被重新分类为较高或较低风险组，总体拟合度显着改善，C 指数更大（P<0.001），并且重新分类的准确性显着提高。对于该模型，NRI 为 8.4%，CNRI 为 15.8%（两个 P 值均 <0.001）。正如之前在女性中所显示的，结合 hsCRP 和父母病史的男性预测模型显着改善了整体心血管风险预测。
High sensitivity C-reactive protein (hsCRP) and family history independently associate with future cardiovascular events and have been incorporated into risk prediction models for women (the Reynolds Risk Score for women). However, no cardiovascular risk prediction algorithm incorporating these variables currently exists for men. Among 10,724 initially healthy American non-diabetic men who were followed prospectively over a median period of 10.8 years, we compared the test characteristics of global model fit, discrimination, calibration, and reclassification in two prediction models for incident cardiovascular events, one based on age, blood pressure, smoking status, total cholesterol, and high-density lipoprotein cholesterol (traditional model), and the other based on these risk factors as well as hsCRP and parental history of myocardial infarction before age 60 years (Reynolds Risk Score for men). 1,294 cardiovascular events accrued during study follow-up. Compared to the traditional model, the Reynolds Risk Score had better global fit (likelihood ratio test P<0.001), a superior (lower) Bayes Information Criterion, and a larger C-index (P<0.001). For the endpoint of all cardiovascular events, the Reynolds Risk Score for men reclassified 17.8 percent [1,904/10,724] of the study population (and 20.2 percent [1,342/6,884] of those at 5 to 20 percent 10-year risk) into higher- or lower-risk categories with markedly improved accuracy among those reclassified. For this model comparison, the net reclassification index (NRI) was 5.3 percent and the clinical net reclassification index (CNRI) was 14.2 percent (both P-values<0.001). In models based on the ATP-III preferred endpoint of coronary heart disease and limited to men not taking lipid-lowering therapy, 16.7 percent of the study population (and 20.1 percent of those at 5 to 20 percent 10-year risk) were reclassified to higher- or lower-risk groups, again with significantly improved global fit, larger C-index (P<0.001), and markedly improved accuracy among those reclassified. For this model, NRI was 8.4 percent and CNRI 15.8 percent (both P-values <0.001). As previously shown in women, a prediction model in men that incorporates hsCRP and parental history significantly improves global cardiovascular risk prediction.