*Department of General Internal Medicine, Division of Vascular Medicine, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
Clin Sci (Lond). 2014 Jan;126(2):139-46. doi: 10.1042/CS20130178.
Cardiovascular risk stratification could be improved by adding measures of atherosclerosis to current risk scores, especially in intermediate-risk individuals. We prospectively evaluated the additive value of different non-invasive risk markers (both individual and combined) for gender-specific cardiovascular risk stratification on top of traditional risk factors in a middle-aged population-based cohort. Carotid-plaques, IMT (intima-media thickness), ABI (ankle-brachial index), PWV (pulse-wave velocity), AIx (augmentation index), CAP (central augmented pressure) and CSP (central-systolic pressure) were measured in 1367 CVD (cardiovascular disease)-free participants aged 50-70 years old. Cardiovascular events were validated after a mean follow-up of 3.8 years. AUC (area-under-the-curve) and NRI (net reclassification improvement) analyses (total-NRI for all and clinical-NRI for intermediate-risk groups) were used to determine the additive value of individual and combined risk markers. Cardiovascular events occurred in 32 women and 39 men. Traditional cardiovascular risk factors explained 6.2% and 12.5% of the variance in CVD in women and men respectively. AUCs did not substantially increase by adding individual or combined non-invasive risk markers. Individual risk markers only improved reclassification in intermediate-risk women and more than in men; clinical-NRIs ranged between 48.0 and 173.1% in women and 8.9 and 20% in men. Combined non-invasive-risk markers improved reclassification in all women and even more in those at intermediate risk; 'IMT-presence-thickness-of-plaques' showed largest reclassification [total-NRI=33.8%, P=0.012; IDI (integrated-discrimination-improvement)=0.048, P=0.066; clinical-NRI=168.0%]. In men, combined non-invasive risk markers improved reclassification only in those at intermediate risk; 'PWV-AIx-CSP-CAP-IMT' showed the largest reclassification (total-NRI=14.5%, P=0.087; IDI=0.016, P=0.148; clinical-NRI=46.0%). In all women, cardiovascular risk stratification improved by adding combinations and in women at intermediate risk also by adding individual non-invasive risk markers. The additive value of individual and combined non-invasive risk markers in men is limited to men at intermediate risk only, and to a lesser extent than in women.
心血管风险分层可以通过在当前风险评分中添加动脉粥样硬化测量值来改善，尤其是在中危人群中。我们前瞻性地评估了不同的非侵入性风险标志物（个体和联合）在中年人群基础队列中对传统危险因素进行性别特异性心血管风险分层的附加价值。在无心血管疾病的 1367 名年龄在 50-70 岁的参与者中测量了颈动脉斑块、IMT（内膜-中层厚度）、ABI（踝臂指数）、PWV（脉搏波速度）、AIx（增强指数）、CAP（中心增强压力）和 CSP（中心收缩压）。在平均 3.8 年的随访后，验证了心血管事件。使用 AUC（曲线下面积）和 NRI（净重新分类改善）分析（所有人群的总 NRI 和中危人群的临床 NRI）来确定个体和联合风险标志物的附加价值。在 32 名女性和 39 名男性中发生了心血管事件。传统心血管危险因素分别解释了女性和男性 CVD 中 6.2%和 12.5%的方差。添加个体或联合非侵入性风险标志物并未显著增加 AUC。个体风险标志物仅改善了中危女性的重新分类，且效果优于男性；临床 NRI 范围在女性为 48.0%至 173.1%，在男性为 8.9%至 20%。联合非侵入性风险标志物改善了所有女性的重新分类，在中危女性中甚至更多；“IMT-存在-斑块厚度”显示出最大的重新分类[总 NRI=33.8%，P=0.012；IDI（综合判别改善）=0.048，P=0.066；临床 NRI=168.0%]。在男性中，联合非侵入性风险标志物仅在中危人群中改善了重新分类；“PWV-AIx-CSP-CAP-IMT”显示出最大的重新分类（总 NRI=14.5%，P=0.087；IDI=0.016，P=0.148；临床 NRI=46.0%）。在所有女性中，通过添加组合，女性中危人群也通过添加个体非侵入性风险标志物，心血管风险分层得到改善。个体和联合非侵入性风险标志物的附加价值在男性中仅限于中危男性，而且程度低于女性。
