Finnish Medical Society Duodecim, Helsinki, Finland.
Eur J Public Health. 2010 Feb;20(1):107-12. doi: 10.1093/eurpub/ckp070. Epub 2009 May 29.
Screening tools to identify persons with high cardiovascular risk exist, but less is known about their validity in different population groups. The aim of this article is to compare the sensitivity and specificity of three different cardiovascular disease risk scores and their ability to detect high-risk individuals in daily practice.
The sensitivity and specificity of risk charts based on Framingham Risk Function, SCORE and cardiovascular disease (CVD) Risk Score were analysed using a large population risk factor survey database in Finland. For different cardiovascular disease end-points in 10-year follow-up true positive, false positive, true negative and false negative cases were identified using different risk charts. Subjects over 40 years (n = 25 059) of the FINRISK Study were used in analyses.
Risk scores differed depending on gender, age and cardiovascular outcome. Among men the sensitivity of CVD Risk Score and Framingham Risk Function at risk of >or=10% for each end point was higher than of SCORE or Framingham Risk Function at risk of 20%. The specificity of Framingham Risk Function at risk of 20% was higher than the specificity of other risk charts. Among women in all endpoints the sensitivity was highest in CVD Risk Score and lowest in Framingham Risk Function at risk of >or=20%. Specificity for all different endpoints was highest in SCORE and Framingham Risk Function at risk of 20%.
Sensitivity and specificity varied markedly in between three cardiovascular risk evaluation tools. Practitioners should be aware of their limitations especially when estimating risk among women and younger patients.
虽然存在用于识别心血管高危人群的筛查工具，但对于它们在不同人群中的有效性知之甚少。本文旨在比较三种不同的心血管疾病风险评分的敏感性和特异性及其在日常实践中识别高危个体的能力。
使用芬兰大型人群风险因素调查数据库分析基于 Framingham 风险函数、SCORE 和心血管疾病（CVD）风险评分的风险图表的敏感性和特异性。在 10 年随访中，对于不同的心血管疾病终点，使用不同的风险图表确定了真正的阳性、假阳性、真正的阴性和假阴性病例。FINRISK 研究中的 40 岁以上（n=25059）的受试者被用于分析。
风险评分因性别、年龄和心血管结局而异。在男性中，CVD 风险评分和 Framingham 风险函数在每个终点处风险 >或=10%的敏感性高于 SCORE 或 Framingham 风险函数在风险 20%的敏感性。Framingham 风险函数风险 20%的特异性高于其他风险图表的特异性。在所有终点中，女性的敏感性最高在 CVD 风险评分和最低在Framingham 风险函数风险 >或=20%。所有不同终点的特异性最高在 SCORE 和 Framingham 风险函数风险 20%。
三种心血管风险评估工具的敏感性和特异性差异很大。医生在评估女性和年轻患者的风险时应注意其局限性。
