非传统风险标志物在动脉粥样硬化性心血管疾病风险评估中的应用

Utility of Nontraditional Risk Markers in Atherosclerotic Cardiovascular Disease Risk Assessment.

作者信息

Yeboah Joseph, Young Rebekah, McClelland Robyn L, Delaney Joseph C, Polonsky Tamar S, Dawood Farah Z, Blaha Michael J, Miedema Michael D, Sibley Christopher T, Carr J Jeffrey, Burke Gregory L, Goff David C, Psaty Bruce M, Greenland Philip, Herrington David M

机构信息

Department of Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston-Salem, North Carolina.

Department of Biostatistics, University of Washington, Seattle, Washington.

出版信息

J Am Coll Cardiol. 2016 Jan 19;67(2):139-147. doi: 10.1016/j.jacc.2015.10.058.

DOI:10.1016/j.jacc.2015.10.058

PMID:26791059

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4724058/

Abstract

BACKGROUND

The improvement in discrimination gained by adding nontraditional cardiovascular risk markers cited in the 2013 American College of Cardiology/American Heart Association cholesterol guidelines to the atherosclerotic cardiovascular disease (ASCVD) risk estimator (pooled cohort equation [PCE]) is untested.

OBJECTIVES

This study assessed the predictive accuracy and improvement in reclassification gained by the addition of the coronary artery calcium (CAC) score, the ankle-brachial index (ABI), high-sensitivity C-reactive protein (hsCRP) levels, and family history (FH) of ASCVD to the PCE in participants of MESA (Multi-Ethnic Study of Atherosclerosis).

METHODS

The PCE was calibrated (cPCE) and used for this analysis. The Cox proportional hazards survival model, Harrell's C statistics, and net reclassification improvement analyses were used. ASCVD was defined as myocardial infarction, coronary heart disease-related death, or fatal or nonfatal stroke.

RESULTS

Of 6,814 MESA participants not prescribed statins at baseline, 5,185 had complete data and were included in this analysis. Their mean age was 61 years; 53.1% were women, 9.8% had diabetes, and 13.6% were current smokers. After 10 years of follow-up, 320 (6.2%) ASCVD events occurred. CAC score, ABI, and FH were independent predictors of ASCVD events in the multivariable Cox models. CAC score modestly improved the Harrell's C statistic (0.74 vs. 0.76; p = 0.04); ABI, hsCRP levels, and FH produced no improvement in Harrell's C statistic when added to the cPCE.

CONCLUSIONS

CAC score, ABI, and FH were independent predictors of ASCVD events. CAC score modestly improved the discriminative ability of the cPCE compared with other nontraditional risk markers.

摘要

背景

在动脉粥样硬化性心血管疾病（ASCVD）风险评估工具（合并队列方程[PCE]）中加入2013年美国心脏病学会/美国心脏协会胆固醇指南中提及的非传统心血管风险标志物后，辨别能力的改善尚未得到验证。

目的

本研究评估了在动脉粥样硬化多族裔研究（MESA）参与者中，将冠状动脉钙化（CAC）评分、踝臂指数（ABI）、高敏C反应蛋白（hsCRP）水平和ASCVD家族史（FH）加入PCE后所获得的预测准确性和重新分类改善情况。

方法

对PCE进行校准（cPCE）并用于本分析。使用Cox比例风险生存模型、Harrell's C统计量和净重新分类改善分析。ASCVD定义为心肌梗死、冠心病相关死亡或致命或非致命性卒中。

结果

在6814名基线时未服用他汀类药物的MESA参与者中，5185名有完整数据并纳入本分析。他们的平均年龄为61岁；53.1%为女性，9.8%患有糖尿病，13.6%为当前吸烟者。经过10年随访，发生了320例（6.2%）ASCVD事件。在多变量Cox模型中，CAC评分、ABI和FH是ASCVD事件的独立预测因素。CAC评分适度改善了Harrell's C统计量（0.74对0.76；p = 0.04）；将ABI、hsCRP水平和FH加入cPCE时，Harrell's C统计量没有改善。