Mainous Arch G, Everett Charles J, Player Marty S, King Dana E, Diaz Vanessa A
Department of Family Medicine, Medical University of South Carolina, 295 Calhoun Street, Charleston, SC 29425, USA.
J Am Board Fam Med. 2008 Sep-Oct;21(5):408-13. doi: 10.3122/jabfm.2008.05.080046.
Although many coronary heart disease (CHD) risk factors are known, the role of an individual's changing personal health history is unclear. We implemented this study to evaluate whether accounting for previous Framingham Risk Scores (FRSs) improves the predictive ability of a current FRS for future CHD in middle-aged adults.
We analyzed data from the Atherosclerosis Risk in Communities Study (ARIC), a longitudinal cohort of people 45 to 64 years old at entry (1986 to 1989 through 2001). FRSs were calculated for participants in the ARIC cohort (3901 men, 5406 women) at baseline (visit 3) and 3 and 6 years before. Using Cox regressions we evaluated the risk of CHD development for the FRS 6 years from baseline and then evaluated whether the addition of the change in FRS assessments from 3 and 6 years before the baseline improved the predictive ability of the FRS. Areas under the receiver operating characteristic (AUROC) curves were compared.
The addition of the difference between the baseline FRS (eg, in 1995) and the FRS from 6 years earlier (eg, in 1989) to predict CHD development by 2001 for the entire cohort yielded an AUROC of 0.730, which was a significant improvement over just using the baseline FRS (P < .05). The effect was located primarily among women, with the AUROC curve improving from 0.667 to 0.709 (P < .05). There was no improvement for CHD risk prediction in men when the earlier FRS assessments were taken into account. Men seem to have less change in some risk factors over time.
Accounting for an individual's history improves risk assessments based on current measures.
虽然已知许多冠心病（CHD）风险因素，但个人不断变化的个人健康史的作用尚不清楚。我们开展这项研究以评估纳入既往弗雷明汉风险评分（FRS）是否能提高当前FRS对中年成年人未来冠心病的预测能力。
我们分析了社区动脉粥样硬化风险研究（ARIC）的数据，该研究是一个纵向队列，入组时年龄为45至64岁（1986年至1989年至2001年）。在基线（第3次访视）以及基线前3年和6年为ARIC队列的参与者（3901名男性，5406名女性）计算FRS。我们使用Cox回归评估了从基线起6年时FRS发生冠心病的风险，然后评估纳入基线前3年和6年FRS评估的变化是否能提高FRS的预测能力。比较了受试者工作特征（AUROC）曲线下的面积。
纳入基线FRS（如1995年）与6年前FRS（如1989年）的差异以预测整个队列到2001年时冠心病的发生，得出的AUROC为0.730，这比仅使用基线FRS有显著改善（P < .05）。这种效应主要见于女性，AUROC曲线从0.667改善至0.709（P < .05）。在考虑早期FRS评估时，男性冠心病风险预测没有改善。男性某些风险因素随时间的变化似乎较小。
纳入个人病史可改善基于当前测量的风险评估。
