Institute of Social and Preventive Medicine ISPM, University of Zurich, Zurich, Switzerland.
PLoS One. 2013;8(2):e56149. doi: 10.1371/journal.pone.0056149. Epub 2013 Feb 14.
Only few countries have cohorts enabling specific and up-to-date cardiovascular disease (CVD) risk estimation. Individual risk assessment based on study samples that differ too much from the target population could jeopardize the benefit of risk charts in general practice. Our aim was to provide up-to-date and valid CVD risk estimation for a Swiss population using a novel record linkage approach.
Anonymous record linkage was used to follow-up (for mortality, until 2008) 9,853 men and women aged 25-74 years who participated in the Swiss MONICA (MONItoring of trends and determinants in CVD) study of 1983-92. The linkage success was 97.8%, loss to follow-up 1990-2000 was 4.7%. Based on the ESC SCORE methodology (Weibull regression), we used age, sex, blood pressure, smoking, and cholesterol to generate three models. We compared the 1) original SCORE model with a 2) recalibrated and a 3) new model using the Brier score (BS) and cross-validation.
Based on the cross-validated BS, the new model (BS = 14107×10(-6)) was somewhat more appropriate for risk estimation than the original (BS = 14190×10(-6)) and the recalibrated (BS = 14172×10(-6)) model. Particularly at younger age, derived absolute risks were consistently lower than those from the original and the recalibrated model which was mainly due to a smaller impact of total cholesterol.
Using record linkage of observational and routine data is an efficient procedure to obtain valid and up-to-date CVD risk estimates for a specific population.
仅有少数国家拥有可用于特定且最新的心血管疾病（CVD）风险评估的队列。基于与目标人群差异过大的研究样本进行个体风险评估可能会危及风险图表在一般实践中的应用效果。我们的目的是使用新的记录链接方法为瑞士人群提供最新且有效的 CVD 风险评估。
使用匿名记录链接来随访（截至 2008 年的死亡率）年龄在 25-74 岁之间的 9853 名男性和女性，他们参加了 1983-92 年的瑞士 MONICA（心血管疾病趋势和决定因素监测）研究。链接成功率为 97.8%，1990-2000 年的随访损失率为 4.7%。基于 ESC SCORE 方法（Weibull 回归），我们使用年龄、性别、血压、吸烟和胆固醇生成了三个模型。我们比较了 1）原始 SCORE 模型与 2）重新校准的模型和 3）使用 Brier 评分（BS）和交叉验证的新模型。
基于交叉验证的 BS，新模型（BS=14107×10(-6)）在风险估计方面比原始模型（BS=14190×10(-6))和重新校准的模型（BS=14172×10(-6))更为合适。特别是在较年轻的年龄，得出的绝对风险始终低于原始模型和重新校准的模型，这主要是由于总胆固醇的影响较小。
使用观察性和常规数据的记录链接是为特定人群获得有效且最新的 CVD 风险估计的有效程序。
