Menzies Research Institute, Hobart, Tasmania, Australia.
Hypertension. 2010 Jul;56(1):44-8. doi: 10.1161/HYPERTENSIONAHA.109.148007. Epub 2010 May 24.
Estimating absolute risk rather than measurement of blood pressure alone is considered the best way to identify those who would most likely benefit from medical intervention. Risk calculators used to estimate risk in those without previous cardiovascular disease (CVD) events are based on the Framingham Heart Study, which had no person >74 years of age at baseline. This needs to be addressed, because age is the most important determinant of risk. We estimated the predictive value of 3 risk equations for CVD end points in the Second Australian National Blood Pressure study cohort (mean age: 71.9 years at baseline). Observed and predicted 5-year incidence rates, chi(2) goodness-of-fit tests, and Harrell C statistic and area under the receiver operator characteristic curve were used to assess the ability of the equations to predict CVD outcomes over 5 years. A recalibration analysis was undertaken. Significant (P<0.05) chi(2) goodness-of-fit statistics were observed using each of the risk equations for myocardial infarction, coronary heart disease, stroke, or CVD morbidity or mortality across age groups and both sex. All of the overall C statistics or the area under the receiver operator characteristic curve indicated modest discrimination of the algorithms for prediction of the outcomes for coronary heart disease and CVD morbidity and mortality, myocardial infarction, or stroke (Framingham); cardiac death (Pocock); and CVD events (Dubbo). Recalibration analyses showed that it would be inappropriate to apply the risk equations to the Second Australian National Blood Pressure study population. New risk equations for CVD events in the hypertensive aged are needed.
评估绝对风险而非单纯测量血压被认为是识别最有可能受益于医疗干预的人群的最佳方法。用于评估无先前心血管疾病 (CVD) 事件人群风险的风险计算器基于弗雷明汉心脏研究，该研究基线时无年龄>74 岁的人群。这是需要解决的问题，因为年龄是风险的最重要决定因素。我们评估了 3 种 CVD 终点风险方程在第二次澳大利亚国家血压研究队列中的预测价值（基线时平均年龄：71.9 岁）。使用观察到的和预测的 5 年发生率、卡方拟合优度检验以及 Harrell C 统计量和接受者操作特征曲线下面积来评估方程预测 CVD 结局的能力超过 5 年。进行了重新校准分析。使用每个风险方程观察到心肌梗死、冠心病、中风或 CVD 发病率或死亡率的卡方拟合优度统计数据在年龄组和两性中均显著（P<0.05）。所有的总体 C 统计量或接受者操作特征曲线下面积均表明算法对预测冠心病和 CVD 发病率和死亡率、心肌梗死或中风（弗雷明汉）、心脏性死亡（波科克）和 CVD 事件（达博）结局的适度区分。重新校准分析表明，将风险方程应用于第二次澳大利亚国家血压研究人群是不恰当的。需要为高血压老年人群制定新的 CVD 事件风险方程。
