Wu Yangfeng, Liu Xiaoqing, Li Xian, Li Ying, Zhao Liancheng, Chen Zuo, Li Yihe, Rao Xuxu, Zhou Beifan, Detrano Robert, Liu Kiang
Department of Epidemiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Circulation. 2006 Nov 21;114(21):2217-25. doi: 10.1161/CIRCULATIONAHA.105.607499. Epub 2006 Nov 6.
Stroke is much more prevalent than coronary heart disease in China; thus, any risk prediction model only for coronary heart disease may not be appropriate in application. Our objective is to develop a cardiovascular risk prediction model appropriate for the Chinese population.
Cox proportional hazards regression was used to develop sex-specific optimal 10-year risk prediction models for ischemic cardiovascular disease (ICVD; including ischemic stroke and coronary events) from 17 years of follow-up data from the USA-PRC Collaborative Study of Cardiovascular Epidemiology cohort, in which 9903 participants were followed up every 2 years until 2000, and 371 ICVD events (266 strokes and 105 coronary heart disease events) occurred. The models showed ICVD was positively related to age, systolic blood pressure, serum total cholesterol, body mass index, current smoking status, and diabetes mellitus in both men and women. When the models were applied to the 17,329 participants in the China Multicenter Collaborative Study of Cardiovascular Epidemiology cohort, the areas under the receiver operating characteristic curve were 0.796+/-0.036 for men and 0.791+/-0.036 for women. The simplified point score model resulted in similar c statistics. Comparison of the observed with the estimated incidence of ICVD at different risk levels showed satisfactory precision. Meanwhile, application of recalibrated Framingham models significantly overestimated the coronary heart disease risk in both men (by approximately 97%) and women (by approximately 228%).
The Cox regression prediction models and simplified point score model have satisfying predictive capability for estimating the 10-year integrated cardiovascular risk in Chinese, in whom stroke is the predominant cardiovascular disease.
在中国，中风比冠心病更为普遍；因此，任何仅针对冠心病的风险预测模型在应用中可能并不合适。我们的目标是开发一种适用于中国人群的心血管风险预测模型。
采用Cox比例风险回归，根据中美心血管病流行病学合作研究队列17年的随访数据，建立了针对缺血性心血管病（ICVD，包括缺血性中风和冠心病事件）的性别特异性最佳10年风险预测模型。该队列中9903名参与者每2年随访一次，直至2000年，共发生371例ICVD事件（266例中风和105例冠心病事件）。模型显示，无论男性还是女性，ICVD均与年龄、收缩压、血清总胆固醇、体重指数、当前吸烟状况和糖尿病呈正相关。当将这些模型应用于中国多中心心血管病流行病学合作研究队列的17329名参与者时，男性受试者工作特征曲线下面积为0.796±0.036，女性为0.791±0.036。简化的积分模型得出了相似的c统计量。不同风险水平下ICVD观察发病率与估计发病率的比较显示出令人满意的精度。同时，重新校准的弗明汉模型的应用显著高估了男性（约97%）和女性（约228%）的冠心病风险。
Cox回归预测模型和简化积分模型在估计中国人群10年综合心血管风险方面具有令人满意的预测能力，在中国，中风是主要的心血管疾病。
