López-Suárez Alejandro, Bascuñana-Quirell Antonio, Beltrán-Robles Manuel, Elvira-González Javier, Fernández-Palacín Fernando, Barroso-Casamitjana Elisa, Solino-Ocaña Isabel
From the Internal Medicine Department, Virgen del Camino Hospital, Carretera de Chipiona, Sanlúcar de Barrameda, Cádiz, Spain (ALS, ABQ, MBR, JEG, EBC, ISO); and Statistic and Operative Research, Faculty of Sciences, University of Cdiz, Avda. República Saharaui s/n, Puerto Real, Cádiz, Spain (FFP).
Medicine (Baltimore). 2014 Dec;93(27):e212. doi: 10.1097/MD.0000000000000212.
Metabolic syndrome (MS) is widely believed to be an important risk factor for cardiovascular disease (CVD). We assessed whether a model based on MS improved prediction of CVD and total mortality over the Framingham's general CVD system (FRS) and whether MS was better than its individual components. Prospective cohort study of 855 participants randomly selected from the general population. Cox proportional hazards models were used to estimate the hazard ratios selecting a composite endpoint of CVD and total mortality. The performance of the FRS was compared with that of 4 MS-based models that differed in their use of individual components of MS as well as in the use of optimized cut-points of MS. The assessment included metrics of discrimination, calibration, and risk reclassification. Of all the models, only the model containing the 5 optimized components of MS improved model fit (deviance 10.7, P = 0.005), discrimination (difference of areas under the receiving operating curves 0.018), and risk reclassification in participants without events (net reclassification index 5.97, P = 0.01). The addition of optimized waist circumference to the FRS model improved the performance more than any other MS-based model. Every model containing the dichotomous definition of MS failed to improve model fit, discrimination, and risk reclassification. MS did not contribute predictive information over the FRS for the 5-year risk of CVD and total mortality. Some individual components of MS, in particular waist circumference, might play a role as part of the FRS provided their cut-off points are optimized.
代谢综合征（MS）被广泛认为是心血管疾病（CVD）的一个重要危险因素。我们评估了基于MS的模型是否比弗雷明汉一般心血管疾病系统（FRS）能更好地预测CVD和全因死亡率，以及MS是否比其各个组成部分更具优势。对从普通人群中随机选取的855名参与者进行了前瞻性队列研究。采用Cox比例风险模型来估计风险比，选取CVD和全因死亡率的复合终点。将FRS的性能与4个基于MS的模型进行比较，这些模型在MS各个组成部分的使用以及MS优化切点的使用上存在差异。评估包括区分度、校准度和风险重新分类等指标。在所有模型中，只有包含MS 5个优化组成部分的模型改善了模型拟合度（偏差10.7，P = 0.005）、区分度（受试者工作特征曲线下面积差异0.018）以及无事件参与者的风险重新分类（净重新分类指数5.97，P = 0.01）。在FRS模型中加入优化的腰围比任何其他基于MS的模型更能改善性能。每个包含MS二分定义的模型都未能改善模型拟合度、区分度和风险重新分类。对于CVD和全因死亡率的5年风险，MS并没有比FRS提供更多的预测信息。MS的一些个别组成部分，特别是腰围，如果其切点经过优化，可能作为FRS的一部分发挥作用。
