Vascular Disease Research Center, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, United States.
Atherosclerosis. 2011 Jun;216(2):452-7. doi: 10.1016/j.atherosclerosis.2011.02.020. Epub 2011 Feb 18.
There is a strong positive association between Framingham Risk Scores (FRS) in a population and incidence of hard coronary heart disease (hCHD) events. Under current Adult Treatment Panel III guidelines, individuals with FRS that indicate ≥20% 10-year risk of hCHD are recommended to receive intensive medical risk factor modification. We sought to assess the performance of FRS as a predictive tool when used as in current guidelines.
A retrospective analysis of two prospective cohort studies, the Atherosclerosis Risk in Communities (ARIC) study, and Cardiovascular Health Study (CHS), including 11,436 and 2569 participants, respectively, without known cardiovascular disease or diabetes at baseline, with available FRS variables were analyzed. The FRS was computed according to standard algorithm. The main outcome was hCHD event defined as MI or coronary death. Using Receiver Operating Characteristics (ROC) curves, sensitivity, specificity, accuracy and other test performance characteristics were determined at various 10-year risk thresholds. ROC curves were plotted.
During 10-year follow-up, 822 hCHD events occurred. FRS was significantly associated with hCHD with an AUC of 0.77 and 0.68 for ARIC and CHS, respectively (p-values <0.0001). However, at standard "high risk" cut-off (≥20%), the sensitivity of FRS was only 13% and 25%, respectively and Youden's Index was only 0.10 and 0.15. Lowering the 10-year risk threshold to >5% improved prediction sensitivity to 75% and 83%, with specificity of 66% and 40%, respectively.
When used dichotomously as in current guidelines, sensitivity of the conventional 20% 10-year risk threshold for subsequent hCHD events is quite low. Since the 20% 10-year risk threshold for intensive medical risk factor therapy is on the steep part of the ROC curve, lowering the threshold results in substantial increases in sensitivity with much smaller losses in specificity, even to a threshold as low as 5%.
人群中的弗雷明汉风险评分（FRS）与硬冠状动脉心脏病（hCHD）事件的发生率之间存在很强的正相关关系。根据现行成人治疗小组 III 指南，FRS 指示 10 年 hCHD 风险≥20%的个体建议接受强化医学危险因素修正。我们试图评估 FRS 作为当前指南中使用的预测工具的性能。
对两项前瞻性队列研究，即动脉粥样硬化风险社区（ARIC）研究和心血管健康研究（CHS）的回顾性分析，分别包括 11436 名和 2569 名基线时无已知心血管疾病或糖尿病且可获得 FRS 变量的参与者。FRS 根据标准算法计算。主要结局为 hCHD 事件定义为 MI 或冠状动脉死亡。使用接收者操作特征（ROC）曲线，在各种 10 年风险阈值下确定灵敏度、特异性、准确性和其他测试性能特征。绘制 ROC 曲线。
在 10 年随访期间，发生了 822 例 hCHD 事件。FRS 与 hCHD 显著相关，ARIC 和 CHS 的 AUC 分别为 0.77 和 0.68（p 值<0.0001）。然而，在标准的“高风险”截止值（≥20%）下，FRS 的灵敏度仅为 13%和 25%，Youden 指数仅为 0.10 和 0.15。将 10 年风险阈值降低至>5%可将预测灵敏度提高至 75%和 83%，特异性分别为 66%和 40%。
当按照现行指南将其作为二项式使用时，传统的 20% 10 年风险阈值用于预测随后的 hCHD 事件的灵敏度相当低。由于强化医学危险因素治疗的 20% 10 年风险阈值位于 ROC 曲线的陡峭部分，因此降低阈值会导致灵敏度大幅提高，特异性损失较小，甚至降低至 5%。
