Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Liver Int. 2012 Jul;32(6):945-50. doi: 10.1111/j.1478-3231.2011.02753.x. Epub 2012 Feb 2.
The accuracy of the Framingham risk score (FRS) in identifying patients with nonalcoholic fatty liver disease (NAFLD) at higher 10-year coronary heart disease (CHD) risk remains unknown. We aimed at evaluating both the baseline probability of CHD as predicted by the FRS and the actual long-term occurrence of CHD in NAFLD patients. This was a longitudinal study of a community-based cohort. A total of 309 NAFLD patients were followed up for 11.5 ± 4.1 years (total 3554 person-years). The overall calculated 10-year CHD risk was significantly higher in the NAFLD cohort than the absolute CHD risk predicted by the FRS for persons of the same age and gender (10.9 ± 9.3% vs. 9.9 ± 5.9%, respectively, P < 0.0001), and higher in men than women (12.6 ± 10.3% vs. 9.6 ± 8.1%, respectively, P = 0.006). New onset CHD occurred in 34 patients (11% vs. 10.9% predicted at baseline, P = NS), whereas 279 (89%) patients did not develop CHD. Using multivariable analysis, the FRS was the only variable significantly associated with new onset CHD (OR = 1.13, 95% CI = 1.05-1.21; P = 0.001). A FRS cut-point of 11 in women, and 6 in men had a sensitivity of 80% and 74%, respectively, and a negative predictive value of 97% and 93% respectively. NAFLD patients have a higher 10-year CHD risk than the general population of the same age and gender. The FRS accurately predicts the higher 10-year CHD risk in NAFLD patients, and helps identify those patients expected to derive the most benefit from early intervention to prevent CHD events.
弗雷明汉风险评分（Framingham risk score，FRS）在识别非酒精性脂肪性肝病（nonalcoholic fatty liver disease，NAFLD）患者中冠心病（coronary heart disease，CHD）10 年风险较高方面的准确性尚不清楚。我们旨在评估 FRS 预测的基线 CHD 概率和 NAFLD 患者的实际长期 CHD 发生情况。这是一项基于社区的队列纵向研究。共随访 309 例 NAFLD 患者 11.5±4.1 年（总 3554 人年）。NAFLD 患者的总体计算 10 年 CHD 风险明显高于 FRS 预测的相同年龄和性别的个体的绝对 CHD 风险（分别为 10.9±9.3%和 9.9±5.9%，P<0.0001），男性高于女性（分别为 12.6±10.3%和 9.6±8.1%，P=0.006）。34 例患者（11%）新发 CHD（与基线预测的 10.9%相比，P=NS），279 例（89%）患者未发生 CHD。多变量分析显示，FRS 是唯一与新发 CHD 显著相关的变量（OR=1.13，95%CI=1.05-1.21；P=0.001）。女性 FRS 截断值为 11，男性为 6，其敏感性分别为 80%和 74%，阴性预测值分别为 97%和 93%。NAFLD 患者的 10 年 CHD 风险高于同年龄和性别普通人群。FRS 准确预测了 NAFLD 患者较高的 10 年 CHD 风险，并有助于识别那些预计从早期干预预防 CHD 事件中获益最多的患者。
