Pereira T, Maldonado J, Polónia J, Silva J A, Morais J, Rodrigues T, Marques M
Escola Superior de Tecnologia da Saúde de Coimbra , Coimbra , Portugal ; Universidade Metodista de Angola , Luanda , Angola.
Blood Press. 2014 Apr;23(2):109-15. doi: 10.3109/08037051.2013.823760. Epub 2013 Aug 14.
HeartSCORE is a tool for assessing cardiovascular risk, basing its estimates on the relative weight of conventional cardiovascular risk factors. However, new markers of cardiovascular risk have been identified, such as aortic pulse wave velocity (PWV). The purpose of this study was to evaluate to what extent the incorporation of PWV in HeartSCORE increases its discriminative power of major cardiovascular events (MACE).
This study is a sub-analysis of the EDIVA project, which is a prospective cohort, multicenter and observational study involving 2200 individuals of Portuguese nationality (1290 men and 910 women) aged between 18 and 91 years (mean 46.33 ± 13.76 years), with annual measurements of PWV (Complior). Only participants above 35 years old were included in the present re-analysis, resulting in a population of 1709 participants. All MACE - death, cerebrovascular accident, coronary accidents (coronary heart disease), peripheral arterial disease and renal failure - were recorded. During a mean follow-up period of 21.42 ± 10.76 months, there were 47 non-fatal MACE (2.1% of the sample). Cardiovascular risk was estimated in all patients based on the HeartSCORE risk factors. For the analysis, the refitted HeartSCORE and PWV were divided into three risk categories. The event-free survival at 2 years was 98.6%, 98.0% and 96.1%, respectively in the low-, intermediate- and high-risk categories of HeartSCORE (log-rank p < 0.001). The multi-adjusted hazard ratio (HR) per 1 - standard deviation (SD) of MACE was 1.86 (95% CI 1.37-2.53, p < 0.001) for PWV. The risk of MACE by tertiles of PWV and risk categories of the HeartSCORE increased linearly, and the risk was particularly more pronounced in the highest tertile of PWV for any category of the HeartSCORE, demonstrating an improvement in the prediction of cardiovascular risk. It was clearly depicted a high discriminative capacity of PWV even in groups of apparent intermediate cardiovascular risk. Measures of model fit, discrimination and calibration revealed an improvement in risk classification when PWV was added to the risk-factor model. The C statistics improved from 0.69 to 0.78 (adding PWV, p = 0.005). The net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were also determined, and indicated further evidence of improvements in discrimination of the outcome when including PWV in the risk-factor model (NRI = 0.265; IDI = 0.012).
The results clearly illustrate the benefits of integrating PWV in the risk assessment strategies, as advocated by HeartSCORE, insofar as it contributes to a better discriminative capacity of global cardiovascular risk, particularly in individuals with low or moderate cardiovascular risk.
HeartSCORE是一种用于评估心血管风险的工具，其评估基于传统心血管危险因素的相对权重。然而，已发现了心血管风险的新标志物，如主动脉脉搏波速度（PWV）。本研究的目的是评估将PWV纳入HeartSCORE能在多大程度上提高其对主要心血管事件（MACE）的鉴别能力。
本研究是EDIVA项目的一项亚分析，EDIVA项目是一项前瞻性队列、多中心观察性研究，涉及2200名18至91岁（平均46.33±13.76岁）的葡萄牙籍个体（1290名男性和910名女性），每年测量PWV（Complior）。本重新分析仅纳入35岁以上的参与者，最终有1709名参与者。记录了所有MACE——死亡、脑血管意外、冠状动脉意外（冠心病）、外周动脉疾病和肾衰竭。在平均21.42±10.76个月的随访期内，有47例非致命MACE（占样本的2.1%）。基于HeartSCORE危险因素对所有患者进行心血管风险评估。为进行分析，将重新拟合的HeartSCORE和PWV分为三个风险类别。HeartSCORE低、中、高风险类别在2年时的无事件生存率分别为98.6%、98.0%和96.1%（对数秩检验p<0.001）。PWV每增加1个标准差（SD），MACE的多因素调整风险比（HR）为1.86（95%CI 1.37 - 2.53，p<0.001）。PWV三分位数和HeartSCORE风险类别对应的MACE风险呈线性增加，并且在HeartSCORE的任何类别中，PWV最高三分位数的风险尤为明显，表明心血管风险预测有所改善。即使在明显的中度心血管风险组中，也清楚地显示出PWV具有较高的鉴别能力。模型拟合、鉴别和校准的测量结果显示，当将PWV添加到风险因素模型中时，风险分类有所改善。C统计量从0.69提高到0.78（添加PWV，p = 0.005）。还确定了净重新分类改善（NRI）和综合鉴别改善（IDI），表明在风险因素模型中纳入PWV时，有进一步证据表明对结局的鉴别有所改善（NRI = 0.265；IDI = 0.012）。
结果清楚地说明了按照HeartSCORE所倡导的，将PWV纳入风险评估策略的益处，因为它有助于更好地鉴别总体心血管风险，特别是在心血管风险低或中度的个体中。
