Liao Y, McGee D L, Cooper R S, Sutkowski M B
Department of Preventive Medicine and Epidemiology and the Division of General Internal Medicine, Loyola University Stritch School of Medicine, Maywood, IL 60153, USA.
Am Heart J. 1999 May;137(5):837-45. doi: 10.1016/s0002-8703(99)70407-2.
Previous models used to predict individual risk of death from coronary heart disease (CHD) were developed from data of 3 decades ago from the Framingham Heart Study. CHD mortality rates have declined markedly since that period as a result of improvement in both risk factor status and medical interventions. Generalization of the results from this one study to the population at large remains a matter of concern. We compared predictive functions derived from the major risk factors for CHD from Framingham and 2 more recent national cohorts, the First and Second National Health and Nutrition Examination Survey (NHANES I and NHANES II).
The participants included 1846 men and 2323 women 35 to 69 years of age and free of CHD at the fourth examination (1954 to 1958) from the Framingham Study; 2753 men and 3858 women from the NHANES I (1971 to 1975); and 2655 men and 3050 women from NHANES II (1976 to 1980). The 3 cohorts were monitored for 24, 20, and 15 years, respectively. Significant heterogeneity existed among studies in the magnitude of the Cox coefficients for the individual factors (ie, age, systolic blood pressure, serum total cholesterol, and smoking status), especially among men. When risk factors were considered collectively, however, functions derived from and applied to different cohorts had a similar ability to rank individual risk. The areas under the receiver operating characteristic curves were 0. 71 to 0.76 in men and 0.76 to 0.81 in women when different risk functions were applied to their own population or to a second population. The cumulative CHD survival observed in women in the 2 national cohorts was close to what was predicted from the Framingham equation. However, Framingham overestimated the cumulative CHD mortality rates in men in NHANES I and NHANES II.
The Framingham risk model for the prediction of CHD mortality rates provides a reasonable rank ordering of risk for individuals in the US white population for the period 1975 to 1990. However, prediction of absolute risk is less accurate.
以往用于预测冠心病（CHD）个体死亡风险的模型是基于30年前弗明汉心脏研究的数据开发的。自那时以来，由于危险因素状况和医疗干预措施的改善，冠心病死亡率显著下降。将这项单一研究的结果推广至广大人群仍然是一个令人担忧的问题。我们比较了从弗明汉以及另外两个近期全国队列——第一次和第二次全国健康与营养检查调查（NHANES I和NHANES II）中得出的冠心病主要危险因素的预测函数。
参与者包括弗明汉研究中在第四次检查（1954年至1958年）时年龄在35至69岁且无冠心病的1846名男性和2323名女性；NHANES I（1971年至1975年）中的2753名男性和3858名女性；以及NHANES II（1976年至1980年）中的2655名男性和3050名女性。这3个队列分别接受了24年、20年和15年的监测。各研究中个体因素（即年龄、收缩压、血清总胆固醇和吸烟状况）的Cox系数大小存在显著异质性，尤其是在男性中。然而，当综合考虑危险因素时，从不同队列得出并应用于不同队列的函数对个体风险进行排序的能力相似。当将不同风险函数应用于各自人群或另一人群时，男性受试者工作特征曲线下面积为0.71至0.76，女性为0.76至0.81。在两个全国队列中观察到的女性冠心病累积生存率与弗明汉方程预测的结果相近。然而，弗明汉高估了NHANES I和NHANES II中男性的冠心病累积死亡率。
用于预测冠心病死亡率的弗明汉风险模型为1975年至1990年期间美国白人人群个体的风险提供了合理的排序。然而，对绝对风险的预测准确性较低。
