Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
Eur J Prev Cardiol. 2012 Aug;19(4):840-8. doi: 10.1177/1741826711410256. Epub 2011 May 6.
To re-estimate the SCORE risk function using individual data on risk factors and coronary heart disease (CHD) incidence from the Dutch Cardiovascular Registry Maastricht (CAREMA) population-based cohort study; to evaluate changes that may improve risk prediction after re-estimation; and to compare the performance of the resulting CAREMA risk function with that of existing risk scores.
The cohort consisted of 21,148 participants, born in 1927-1977 and randomly sampled from the Maastricht region in 1987-1997. After follow-up (median 10.9 years), 783 incident CHD cases occurred. Model performance was assessed by discrimination and calibration. The additional value of including other risk factors or current risk factors in a different manner was evaluated using the net reclassification index (NRI). The c statistic of the re-estimated SCORE model was 0.799 (95% CI 0.782-0.816). Separating the total/high-density lipoprotein (HDL) cholesterol ratio into total and HDL cholesterol levels did not improve the c statistic (p = 0.22), but reclassified 6.0% of the participants into a more appropriate risk category (p < 0.001) compared with the re-estimated model. The resulting CAREMA function reclassified 28% of the participants into a more appropriate risk category than the Framingham score. Compared with the SCORE functions for high- and low-risk regions, the NRIs were 28% and 35%, respectively, which can largely be explained by the difference in outcome definition (CHD incidence vs. CHD mortality).
In this Dutch population, a re-estimated SCORE function with total and HDL cholesterol levels instead of the cholesterol ratio can be used for the risk prediction of CHD incidence.
使用荷兰心血管登记处马斯特里赫特（CAREMA）基于人群的队列研究中的个体危险因素和冠心病（CHD）发病数据重新估计 SCORE 风险函数；评估重新估计后可能改善风险预测的变化；并比较由此产生的 CAREMA 风险函数与现有风险评分的性能。
该队列由 21148 名参与者组成，出生于 1927 年至 1977 年，于 1987 年至 1997 年从马斯特里赫特地区随机抽样。随访（中位数 10.9 年）后，发生了 783 例冠心病事件。通过区分度和校准评估模型性能。使用净重新分类指数（NRI）评估以不同方式纳入其他危险因素或当前危险因素的附加价值。重新估计的 SCORE 模型的 c 统计量为 0.799（95%CI 0.782-0.816）。将总/高密度脂蛋白（HDL）胆固醇比值分为总胆固醇和 HDL 胆固醇水平并没有提高 c 统计量（p=0.22），但与重新估计的模型相比，有 6.0%的参与者被重新分类到更合适的风险类别（p<0.001）。与重新估计的模型相比，由此产生的 CAREMA 函数将 28%的参与者重新分类到更合适的风险类别。与高风险和低风险地区的 SCORE 函数相比，NRI 分别为 28%和 35%，这主要可以用结局定义（CHD 发病率与 CHD 死亡率）的差异来解释。
在荷兰人群中，用总胆固醇和 HDL 胆固醇水平代替胆固醇比值的重新估计的 SCORE 函数可用于 CHD 发病率的风险预测。
