Cardiology Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
Am J Cardiol. 2012 Dec 1;110(11):1627-30. doi: 10.1016/j.amjcard.2012.07.018. Epub 2012 Aug 23.
Methods to improve coronary heart disease (CHD) risk prediction include incorporation of coronary artery calcium (CAC) within risk models and considering longer time horizons such as evaluation of lifetime cardiovascular risk (LTR). We compared the accuracy of 10-year Framingham risk score (FRS), LTR, and Multi-Ethnic Study of Atherosclerosis (MESA) arterial age-adjusted 10-year risk for prediction of incident CHD events in men in the Prospective Army Coronary Calcium Project. We studied 1,633 healthy men (mean age 43 years, range 40 to 50 years, mean FRS 4.6%) with electron-beam computed tomography for CAC. Events (CHD death, myocardial infarction, acute coronary syndrome with nonelective coronary revascularization) were prospectively assessed over 5.6 ± 1.5 years. Predicted risk using 10-year FRS for CHD and cardiovascular disease, LTR, and MESA arterial age were evaluated in relation with CAC and CHD events. CAC prevalence was strongly related to LTR, increasing in a graded fashion from 10.1% to 66.7% across 8 categories of increasing LTR. On receiver operating characteristic analysis, MESA arterial age (area under curve 0.78, 95% confidence interval 0.64 to 0.93) had the largest area under the curve but similar areas under the curve were observed for 10-year risk (CHD 0.74, 0.61 to 0.86; cardiovascular disease 0.70, 0.59 to 0.82), LTR (0.68, 0.49 to 0.76), and LTR with CAC as a covariate (0.76, 0.63 to 0.89). Inclusion of family history of CHD or body mass index did not improve model accuracy. In conclusion, increasing LTR was associated with increasingly prevalent CAC in this low-risk cohort and inclusion of CAC improved the accuracy of LTR for short-term event prediction.
方法包括在风险模型中纳入冠状动脉钙（CAC）和考虑更长的时间范围，如评估终生心血管风险（LTR），以提高冠心病（CHD）风险预测的准确性。我们比较了 10 年 Framingham 风险评分（FRS）、LTR 和多民族动脉粥样硬化研究（MESA）动脉年龄校正的 10 年风险在预测 Prospective Army Coronary Calcium Project 中男性 CHD 事件中的准确性。我们研究了 1633 名健康男性（平均年龄 43 岁，范围 40 至 50 岁，平均 FRS 为 4.6%），使用电子束计算机断层扫描（CT）进行 CAC 检测。前瞻性评估了 5.6±1.5 年的事件（CHD 死亡、心肌梗死、非选择性冠状动脉血运重建的急性冠状动脉综合征）。根据 CAC 和 CHD 事件，评估了使用 10 年 FRS 预测 CHD 和心血管疾病、LTR 和 MESA 动脉年龄与 CAC 的关系。CAC 的患病率与 LTR 密切相关，从 LTR 逐渐升高的 8 个类别中，患病率从 10.1%增加到 66.7%。在接收者操作特征分析中，MESA 动脉年龄（曲线下面积 0.78，95%置信区间 0.64 至 0.93）具有最大的曲线下面积，但观察到 10 年风险（CHD 0.74，0.61 至 0.86；心血管疾病 0.70，0.59 至 0.82）、LTR（0.68，0.49 至 0.76）和将 CAC 作为协变量纳入 LTR（0.76，0.63 至 0.89）的曲线下面积相似。纳入 CHD 家族史或体重指数并不能提高模型的准确性。总之，在这个低危队列中，LTR 的增加与 CAC 的患病率呈正相关，并且 CAC 的纳入提高了 LTR 对短期事件预测的准确性。
