Macleod John, Metcalfe Chris, Smith George Davey, Hart Carole
Department of Primary Care and General Practice, Primary Care Clinical Sciences and Learning Centre Building, University of Birmingham, Edgbaston, Birmingham, UK.
J Epidemiol Community Health. 2007 Sep;61(9):833-7. doi: 10.1136/jech.2006.055921.
To assess the value of psychosocial risk factors in discriminating between individuals at higher and lower risk of coronary heart disease, using risk prediction equations.
Prospective observational study.
Scotland.
5191 employed men aged 35 to 64 years and free of coronary heart disease at study enrollment
Area under receiver operating characteristic (ROC) curves for risk prediction equations including different risk factors for coronary heart disease.
During the first 10 years of follow up, 203 men died of coronary heart disease and a further 200 were admitted to hospital with this diagnosis. Area under the ROC curve for the standard Framingham coronary risk factors was 74.5%. Addition of "vital exhaustion" and psychological stress led to areas under the ROC curve of 74.5% and 74.6%, respectively. Addition of current social class and lifetime social class to the standard Framingham equation gave areas under the ROC curve of 74.6% and 74.9%, respectively. In no case was there strong evidence for improved discrimination of the model containing the novel risk factor over the standard model.
Consideration of psychosocial risk factors, including those that are strong independent predictors of heart disease, does not substantially influence the ability of risk prediction tools to discriminate between individuals at higher and lower risk of coronary heart disease.
使用风险预测方程评估心理社会风险因素在区分冠心病高风险和低风险个体方面的价值。
前瞻性观察性研究。
苏格兰。
5191名年龄在35至64岁之间、在研究入组时无冠心病的在职男性。
包含不同冠心病风险因素的风险预测方程的受试者工作特征（ROC）曲线下面积。
在随访的前10年中，203名男性死于冠心病，另有200名因该诊断入院。标准弗明汉姆冠心病风险因素的ROC曲线下面积为74.5%。加入“体力耗竭”和心理压力后，ROC曲线下面积分别为74.5%和74.6%。在标准弗明汉姆方程中加入当前社会阶层和终生社会阶层后，ROC曲线下面积分别为74.6%和74.9%。在任何情况下，都没有强有力的证据表明包含新风险因素的模型比标准模型在区分能力上有改善。
考虑心理社会风险因素，包括那些心脏病的强独立预测因素，并不会实质性地影响风险预测工具区分冠心病高风险和低风险个体的能力。
