Saidj Madina, Jørgensen Torben, Prescott Eva, Borglykke Anders
Forskningscenter for Forebyggelse og Sundhed, Koncern Plan Udvikling og Kvalitet, Afsnit 84/85, Glostrup Hospital, 2600 Glostrup, Denmark.
Dan Med J. 2013 May;60(5):A4609.
In Denmark, the European risk chart Systematic COronary Risk Evaluation (SCORE) from the European Society of Cardiology is recommended for use in cardiovascular prevention. Nevertheless, its predictive ability in a Danish population has never been investigated. The purpose of this study was therefore to assess the predictive ability of the SCORE risk chart with regard to fatal cardiovascular risk according to the socio-demographic factors of age, sex, income and education in a Danish population.
Data from the third Copenhagen City Heart Study (n = 4,224) were linked to the Danish Cause of Death Registry. Calibration (i.e. Hosmer-Lemeshow goodness-of-fit), expected-to-observed (E/O) mortality ratios in the total population and for subgroups, as well as discrimination (i.e. sensitivity, specificity, Area Under the Receiver Operator Characteristic (AUROC) and predictive values) were tested. Both SCORE high-risk and low-risk were applied for comparison.
The results showed that both SCORE high-risk and low-risk performed acceptably in terms of discrimination (AUROC ≈ 0.7-0.8); however, calibration for both SCORE charts was inadequate (χ2 > 20; p < 0.001). E/O-ratios varied with age, sex and socioeconomic status.
There is a need to recalibrate SCORE to risk levels and risk factor distribution in the Danish population.
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在丹麦，推荐使用欧洲心脏病学会的系统性冠状动脉风险评估（SCORE）欧洲风险图表进行心血管疾病预防。然而，其在丹麦人群中的预测能力从未得到研究。因此，本研究的目的是根据丹麦人群的年龄、性别、收入和教育等社会人口学因素，评估SCORE风险图表对致命心血管风险的预测能力。
来自第三次哥本哈根城市心脏研究（n = 4224）的数据与丹麦死亡原因登记处相关联。测试了校准（即Hosmer-Lemeshow拟合优度）、总体人群和亚组的预期与观察（E/O）死亡率比，以及辨别力（即敏感性、特异性、受试者工作特征曲线下面积（AUROC）和预测值）。同时应用SCORE高风险和低风险进行比较。
结果表明，SCORE高风险和低风险在辨别力方面（AUROC≈0.7 - 0.8）表现尚可；然而，两个SCORE图表的校准均不充分（χ2>20；p<0.001）。E/O比随年龄、性别和社会经济地位而变化。
有必要根据丹麦人群的风险水平和风险因素分布对SCORE进行重新校准。
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