Raiko Juho R H, Magnussen Costan G, Kivimäki Mika, Taittonen Leena, Laitinen Tomi, Kähönen Mika, Hutri-Kähönen Nina, Jula Antti, Loo Britt-Marie, Thomson Russell J, Lehtimäki Terho, Viikari Jorma S A, Raitakari Olli T, Juonala Markus
Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku and Turku University Hospital dFinnish Institute of Occupational Health, Helsinki, Finland.
Eur J Cardiovasc Prev Rehabil. 2010 Oct;17(5):549-55. doi: 10.1097/HJR.0b013e3283386419.
To study the utility of risk scores in the prediction of subclinical atherosclerosis in young adults.
Participants were 2204 healthy Finnish adults aged 24-39 years in 2001 from a population-based follow-up study Cardiovascular Risk in Young Finns. We examined the performance of the Framingham, Reynolds, Systematic Coronary Risk Evaluation (SCORE), PROCAM, and Finrisk cardiovascular risk scores to predict subclinical atherosclerosis, that is carotid artery intima-media thickness (IMT) and plaque, carotid artery distensibility (CDist), and brachial artery flow-mediated dilatation (FMD) 6 years later. In a 6-year prediction of high IMT (highest decile or plaque), areas under the receiver operating characteristic curves (AUC) for baseline Finrisk (0.733), SCORE (0.726), PROCAM (0.712), and Reynolds (0.729) risk scores were similar as for Framingham risk score (0.728, P always ≥0.15). All risk scores had a similar discrimination in predicting low CDist (lowest decile) (0.652, 0.642, 0.639, 0.658, 0.652 respectively, P always ≥0.41). In the prediction of low FMD (lowest decile), Finrisk, PROCAM, Reynolds, and Framingham scores had similar AUCs (0.578, 0.594, 0.582, 0.568, P always ≥0.08) and SCORE discriminated slightly better (AUC=0.596, P<0.05). The prediction of subclinical outcomes was consistent when estimated from other statistical measures of discrimination, reclassification, and calibration.
Cardiovascular disease risk scores had equal value in predicting subclinical atherosclerosis measured by IMT and CDist in young adults. SCORE was more accurate in predicting low FMD than Framingham risk score.
研究风险评分在预测年轻成年人亚临床动脉粥样硬化中的效用。
参与者为2001年来自基于人群的随访研究“年轻芬兰人心血管风险”中的2204名年龄在24 - 39岁的健康芬兰成年人。我们评估了弗雷明汉、雷诺兹、系统性冠状动脉风险评估（SCORE）、PROCAM和芬兰心血管风险评分预测亚临床动脉粥样硬化的性能，即6年后的颈动脉内膜中层厚度（IMT）和斑块、颈动脉扩张性（CDist）以及肱动脉血流介导的扩张（FMD）。在对高IMT（最高十分位数或斑块）进行6年预测时，基线芬兰心血管风险评分（0.733）、SCORE评分（0.726）、PROCAM评分（0.712）和雷诺兹评分（0.729）的受试者工作特征曲线下面积（AUC）与弗雷明汉风险评分（0.728）相似（P始终≥0.15）。所有风险评分在预测低CDist（最低十分位数）方面具有相似的辨别力（分别为0.652、0.642、0.639、0.658、0.652，P始终≥0.41）。在预测低FMD（最低十分位数）时，芬兰心血管风险评分、PROCAM评分、雷诺兹评分和弗雷明汉评分具有相似的AUC（0.578、0.594、0.582、0.568，P始终≥0.08），而SCORE评分辨别力稍好（AUC = 0.596，P < 0.05）。当从其他辨别、重新分类和校准的统计指标进行估计时，亚临床结局的预测是一致的。
心血管疾病风险评分在预测年轻成年人通过IMT和CDist测量的亚临床动脉粥样硬化方面具有同等价值。SCORE评分在预测低FMD方面比弗雷明汉风险评分更准确。
