Paulus Jessica K, Wessler Benjamin S, Lundquist Christine, Lai Lana L Y, Raman Gowri, Lutz Jennifer S, Kent David M
Predictive Analytics and Comparative Effectiveness (PACE) Center (J.K.P., B.S.W., C.L., L.L.Y.L., J.S.L., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine and Center for Clinical Evidence Synthesis (G.R.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA; and Division of Cardiology, Tufts Medical Center, Boston, MA (B.S.W.).
Circ Cardiovasc Qual Outcomes. 2016 Feb;9(2 Suppl 1):S8-15. doi: 10.1161/CIRCOUTCOMES.115.002473.
Several widely used risk scores for cardiovascular disease (CVD) incorporate sex effects, yet there has been no systematic summary of the role of sex in clinical prediction models (CPMs). To better understand the potential of these models to support sex-specific care, we conducted a field synopsis of sex effects in CPMs for CVD.
We identified CPMs in the Tufts Predictive Analytics and Comparative Effectiveness CPM Registry, a comprehensive database of CVD CPMs published from January 1990 to May 2012. We report the proportion of models including sex effects on CVD incidence or prognosis, summarize the directionality of the predictive effects of sex, and explore factors influencing the inclusion of sex. Of 592 CVD-related CPMs, 193 (33%) included sex as a predictor or presented sex-stratified models. Sex effects were included in 78% (53/68) of models predicting incidence of CVD in a general population, versus only 35% (59/171), 21% (12/58), and 17% (12/72) of models predicting outcomes in patients with coronary artery disease, stroke, and heart failure, respectively. Among sex-including CPMs, women with heart failure were at lower mortality risk in 8 of 8 models; women undergoing revascularization for coronary artery disease were at higher mortality risk in 10 of 12 models. Factors associated with the inclusion of sex effects included the number of outcome events and using cohorts at-risk for CVD (rather than with established CVD).
Although CPMs hold promise for supporting sex-specific decision making in CVD clinical care, sex effects are included in only one third of published CPMs.
几种广泛使用的心血管疾病（CVD）风险评分纳入了性别因素，但尚未对性别在临床预测模型（CPM）中的作用进行系统总结。为了更好地理解这些模型支持针对性别护理的潜力，我们对CVD的CPM中的性别效应进行了一项领域综述。
我们在塔夫茨预测分析与比较有效性CPM注册库中识别CPM，该注册库是一个1990年1月至2012年5月发表的CVD CPM的综合数据库。我们报告了包含性别对CVD发病率或预后影响的模型比例，总结了性别的预测效应的方向性，并探讨了影响性别纳入的因素。在592个与CVD相关的CPM中，193个（33%）将性别作为预测因素或呈现了按性别分层的模型。在预测一般人群中CVD发病率的模型中，78%（53/68）纳入了性别效应，而在预测冠状动脉疾病、中风和心力衰竭患者预后的模型中，这一比例分别仅为35%（59/171）、21%（12/58）和17%（12/72）。在纳入性别的CPM中，8个模型中有8个显示心力衰竭女性的死亡风险较低；12个模型中有10个显示接受冠状动脉疾病血运重建的女性死亡风险较高。与纳入性别效应相关的因素包括结局事件的数量以及使用有CVD风险的队列（而非患有已确诊CVD的队列）。
尽管CPM有望支持CVD临床护理中的针对性别决策，但已发表的CPM中只有三分之一纳入了性别效应。
