Kjeldsen Sverre E, Devereux Richard B, Hille Darcy A, Lyle Paulette A, Dahlöf Björn, Julius Stevo, Edelman Jonathan M, Snapinn Steven M, de Faire Ulf, Fyhrquist Frej, Ibsen Hans, Lederballe-Pedersen Ole, Lindholm Lars H, Nieminen Markku S, Omvik Per, Oparil Suzanne, Wedel Hans
University of Oslo, Ullevaal Hospital, N-0407 Oslo, Norway.
Blood Press. 2009;18(6):348-61. doi: 10.3109/08037050903460590.
We assessed readily available patient characteristics, including albuminuria (not included in traditional cardiovascular risk scores), as predictors of cardiovascular events in hypertension with left ventricular hypertrophy (LVH) and developed risk algorithms/scores for outcomes.
The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study compared effects of losartan-based versus atenolol-based therapy on cardiovascular events in 9193 patients with hypertension and LVH. Univariate and multivariate analyses identified baseline variables with significant impact on development of the primary composite endpoint (cardiovascular death, stroke and myocardial infarction) and its components. Multivariate analysis used a Cox regression model with stepwise selection process. Risk scores were developed from coefficients of risk factors from the multivariate analysis, validated internally using naïve and jack-knife procedures, checked for discrimination and calibration, and compared with Framingham coronary heart disease and other risk scores.
LIFE risk scores showed increasing endpoint rates with increasing quintile (first to fifth quintile, composite endpoint 2.8-26.7%, cardiovascular death 0.5-14.4%, stroke 1.2-11.3%, myocardial infarction 1.4-8.1%) and were confirmed with a jack-knife approach that adjusts for potentially optimistic bias. The Framingham coronary heart disease and other risk scores overestimated risk in lower risk patients and underestimated risk in higher risk patients, except for myocardial infarction.
A number of patient characteristics predicted cardiovascular events in patients with hypertension and LVH. Risk scores developed from these patient characteristics, including albuminuria, strongly predicted outcomes and may improve risk assessment of patients with hypertension and LVH and planning of clinical trials.
我们评估了包括蛋白尿（传统心血管风险评分中未包含）在内的易于获取的患者特征，将其作为高血压伴左心室肥厚（LVH）患者心血管事件的预测指标，并开发了针对结局的风险算法/评分。
氯沙坦干预降低高血压终点事件（LIFE）研究比较了以氯沙坦为基础的治疗与以阿替洛尔为基础的治疗对9193例高血压伴LVH患者心血管事件的影响。单因素和多因素分析确定了对主要复合终点（心血管死亡、中风和心肌梗死）及其组成部分的发生有显著影响的基线变量。多因素分析使用逐步选择过程的Cox回归模型。风险评分由多因素分析中的风险因素系数得出，采用朴素法和留一法在内部进行验证，检查其区分度和校准情况，并与弗明汉冠心病风险评分及其他风险评分进行比较。
LIFE风险评分显示，随着五分位数的增加（第一至第五五分位数，复合终点为2.8%-26.7%，心血管死亡为0.5%-14.4%，中风为1.2%-11.3%，心肌梗死为1.4%-8.1%），终点事件发生率升高，并且留一法证实了这一结果，该方法可调整潜在的乐观偏差。除心肌梗死外，弗明汉冠心病风险评分及其他风险评分高估了低风险患者的风险，低估了高风险患者的风险。
许多患者特征可预测高血压伴LVH患者的心血管事件。由这些患者特征（包括蛋白尿）得出的风险评分能有力地预测结局，可能会改善高血压伴LVH患者的风险评估及临床试验规划。
