10-Year Coronary Heart Disease Risk Prediction Using Coronary Artery Calcium and Traditional Risk Factors: Derivation in the MESA (Multi-Ethnic Study of Atherosclerosis) With Validation in the HNR (Heinz Nixdorf Recall) Study and the DHS (Dallas Heart Study).
10-Year Coronary Heart Disease Risk Prediction Using Coronary Artery Calcium and Traditional Risk Factors: Derivation in the MESA (Multi-Ethnic Study of Atherosclerosis) With Validation in the HNR (Heinz Nixdorf Recall) Study and the DHS (Dallas Heart Study).
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DOI：
10.1016/j.jacc.2015.08.035
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发表时间：
2015-10-13
影响因子：
24
通讯作者：
Burke GL
中科院分区：
文献类型：
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作者：
McClelland RL;Jorgensen NW;Budoff M;Blaha MJ;Post WS;Kronmal RA;Bild DE;Shea S;Liu K;Watson KE;Folsom AR;Khera A;Ayers C;Mahabadi AA;Lehmann N;Jöckel KH;Moebus S;Carr JJ;Erbel R;Burke GL
一些研究已经证明，除了传统的危险因素外，使用冠状动脉钙(CAC)预测冠心病(CHD)风险的巨大潜力。然而，到目前为止，还没有制定出包含CAC的风险评分。我们的目标是利用CAC和传统危险因素得出并验证一个新的风险评分，以评估10年的CHD风险。算法的开发是在动脉粥样硬化的多种族研究(MESA)中进行的，这是一项基于社区的前瞻性队列研究，研究对象为6814名年龄在45-84岁之间的参与者，基线时没有临床心脏病，并跟踪了10年。MESA是性别平衡的，包括39%的非西班牙裔白人，12%的华裔美国人，28%的非洲裔美国人和22%的西班牙裔美国人。亨氏·尼斯多夫回忆研究(HNR)和达拉斯心脏研究(DHS)进行了外部验证。将CAC纳入MESA风险评分提供了显著的风险预测改进(C-统计量0.80vs.0.75p<；0.0001)。HNR和DHS的外部验证提供了非常好的区分和校准的证据。哈雷尔的C-统计量在卫生和公众服务部为0.779，在国土安全部为0.816。此外，事件和非事件之间估计的10年风险差异约为8-9%，表明具有极好的区分性。平均校准，或整体校准，对两项研究都很好，平均预测的10年风险在观察到的事件发生率的0.5%以内。使用传统的危险因素和CAC可以获得对10年冠心病风险的准确估计。MESA风险评分可在MESA网站上在线获得，便于使用，可用于帮助临床医生向患者传达风险，并在确定基于风险的治疗策略时使用。
Several studies have demonstrated the tremendous potential of using coronary artery calcium (CAC) in addition to traditional risk factors for coronary heart disease (CHD) risk prediction. However, to date no risk score incorporating CAC has been developed. Our goal was to derive and validate a novel risk score to estimate 10-year CHD risk using CAC and traditional risk factors. Algorithm development was conducted in the Multi-Ethnic Study of Atherosclerosis (MESA), a prospective community-based cohort study of 6814 participants aged 45–84, free of clinical heart disease at baseline and followed for 10 years. MESA is gender balanced and included 39% Non-Hispanic whites, 12% Chinese American, 28% African American, and 22% Hispanic Americans. External validation was conducted in the Heinz Nixdorf Recall Study (HNR) and the Dallas Heart Study (DHS). Inclusion of CAC in the MESA risk score offered significant improvements in risk prediction (C-statistic 0.80 versus 0.75, p<0.0001). External validation in both HNR and DHS provided evidence of very good discrimination and calibration. Harrell’s C-statistic was 0.779 in HNR, and 0.816 in DHS. Additionally the difference in estimated 10-year risk between events and non-events was approximately 8–9%, indicating excellent discrimination. Mean calibration, or calibration-in-the-large, was excellent for both studies, with average predicted 10-year risk within half a percent of the observed event rate. An accurate estimate of 10-year CHD risk can be obtained using traditional risk factors and CAC. The MESA risk score, which is available online on the MESA web site for easy use, can be used to aid clinicians in the communication of risk to patients and when determining risk-based treatment strategies.