Netherlands Heart Foundation, The Hague, The Netherlands.
Eur J Prev Cardiol. 2013 Oct;20(5):793-9. doi: 10.1177/2047487312444233. Epub 2012 Mar 28.
In clinical practice, individuals at increased risk of cardiovascular diseases (CVD) are identified on the basis of age, sex, smoking, blood pressure, and serum total and high-density lipoprotein cholesterol. We examined whether CVD risk prediction improved when obesity (body mass index ≥30 kg/m(2)) and premature (<70 years) parental myocardial infarction (MI) were added to the classical risk factor model.
Risk factors were measured in 1993-97 in 12,818 participants (53% female) aged 35-65 in the Dutch MORGEN project. Cases of fatal and nonfatal CVD during 10 years of follow up were identified through record linkage. Classical risk factor equations, obtained by Cox proportional hazard analysis, were extended with obesity, paternal MI, and maternal MI. We calculated the net reclassification index (NRI), a measure for correct reclassification of subjects, to check improvement in risk prediction using 5 and 10% increments in absolute CVD risk.
A CVD event occurred in 280 men and 140 women. Obesity and maternal MI were positively and significantly related to total CVD after adjustment for classical risk factors (both hazard ratios ∼1.5). Adding obesity and parental MI to CVD risk prediction yielded a significant NRI of 4.5% in men and a non-significant NRI of 2.6% in women when 5% risk categories were used. For 10% categories, the NRIs were slightly larger (5.5% and 3.3%, respectively). The improvements in risk prediction were mainly due to obesity.
Modest improvements in CVD risk prediction can be obtained when obesity and, to a lesser extent, parental MI are added to the risk function.
在临床实践中，心血管疾病（CVD）风险增加的个体是基于年龄、性别、吸烟、血压以及血清总胆固醇和高密度脂蛋白胆固醇来确定的。我们研究了当肥胖（体重指数≥30kg/m2）和早发（<70 岁）父母心肌梗死（MI）被添加到经典风险因素模型中时，CVD 风险预测是否会得到改善。
1993-97 年，在荷兰 MORGEN 项目中，对 12818 名年龄在 35-65 岁的参与者进行了风险因素测量（53%为女性）。通过记录链接确定了 10 年随访期间致命和非致命 CVD 的病例。通过 Cox 比例风险分析获得的经典风险因素方程，通过扩展肥胖、父代 MI 和母代 MI 进行了扩展。我们计算了净重新分类指数（NRI），这是一种衡量受试者正确重新分类的指标，以检查使用 5%和 10%绝对 CVD 风险增加时风险预测的改善情况。
280 名男性和 140 名女性发生了 CVD 事件。肥胖和母代 MI 在调整经典风险因素后与总 CVD 呈正相关且显著相关（两者的危险比均约为 1.5）。当使用 5%风险类别时，将肥胖和父母 MI 添加到 CVD 风险预测中，男性的 NRI 显著增加 4.5%，女性的 NRI 增加 2.6%。对于 10%类别，NRI 略大（分别为 5.5%和 3.3%）。风险预测的改善主要归因于肥胖。
当将肥胖和在较小程度上父母 MI 添加到风险函数中时，CVD 风险预测可以适度改善。
