Population Health Research Institute, Hamilton Health Sciences, McMaster University, David Braley Cardiovascular Stroke Research Institute, Hamilton, ON, Canada.
Eur Heart J. 2011 Mar;32(5):581-9. doi: 10.1093/eurheartj/ehq448. Epub 2010 Dec 22.
Summating risk factor burden is a useful approach in the assessment of cardiovascular risk among apparently healthy individuals. We aimed to derive and validate a new score for myocardial infarction (MI) risk using modifiable risk factors, derived from the INTERHEART case-control study (n = 19 470).
Multiple logistic regression was used to create the INTERHEART Modifiable Risk Score (IHMRS). Internal validation was performed using split-sample methods. External validation was performed in an international prospective cohort study. A risk model including apolipoproteins, smoking, second-hand smoke exposure, hypertension, and diabetes was developed. Addition of further modifiable risk factors did not improve score discrimination in an external cohort. Split-sample validation studies showed an area under the receiver-operating characteristic (ROC) curve c-statistic of 0.71 [95% confidence interval (CI): 0.70, 0.72]. The IHMRS was positively associated with incident MI in a large cohort of people at low risk for cardiovascular disease [12% increase in MI risk (95% CI: 8, 16%) with a 1-point increase in score] and showed appropriate discrimination in this cohort (ROC c-statistic 0.69, 95% CI: 0.64, 0.74). Results were consistent across ethnic groups and geographic regions. A non-laboratory-based score is also supplied.
Using multiple modifiable risk factors from the INTERHEART case-control study, we have developed and validated a simple score for MI risk which is applicable to an international population.
在评估看似健康个体的心血管风险时，综合危险因素是一种有用的方法。我们旨在使用可改变的危险因素（来源于 INTERHEART 病例对照研究），来开发和验证一种新的心肌梗死（MI）风险评分。
使用多元逻辑回归来创建 INTERHEART 可改变危险因素评分（IHMRS）。采用样本拆分法进行内部验证。在国际前瞻性队列研究中进行外部验证。开发了一个包含载脂蛋白、吸烟、二手烟暴露、高血压和糖尿病的风险模型。在外部队列中，增加其他可改变的危险因素并没有改善评分的区分度。样本拆分验证研究显示，接受者操作特征曲线（ROC）下面积的 C 统计量为 0.71[95%置信区间（CI）：0.70，0.72]。在心血管疾病低危人群的大型队列中，IHMRS 与 MI 事件呈正相关[评分每增加 1 分，MI 风险增加 12%（95%CI：8，16%）]，并且在该队列中具有适当的区分度（ROC C 统计量 0.69，95%CI：0.64，0.74）。结果在不同种族和地理区域中是一致的。还提供了一个非实验室评分。
使用 INTERHEART 病例对照研究中的多个可改变危险因素，我们开发并验证了一种适用于国际人群的 MI 风险的简单评分。
