Barkas Fotios, Elisaf Moses, Korantzopoulos Panagiotis, Tsiara Stavroula, Liberopoulos Evangelos
Department of Internal Medicine, School of Medicine, University of Ioannina, Greece.
Department of Cardiology, School of Medicine, University of Ioannina, Greece.
Int J Cardiol. 2017 Aug 15;241:194-199. doi: 10.1016/j.ijcard.2017.04.062. Epub 2017 Apr 20.
To investigate the value of CHADS and CHADS-VASc scores in predicting atrial fibrillation (AF) among dyslipidemic individuals and assess the additional value of incorporating low levels of high-density lipoprotein cholesterol (HDL-C).
This observational study included 1241 individuals attending a lipid clinic. Models including clinical and laboratory parameters were constructed to test the predictive value of CHADS and CHADS-VASc scores as well as low HDL-C levels for incident AF. Low HDL-C levels were defined as <40 and <50mg/dL for male and female subjects, respectively.
After excluding 18 patients with AF at baseline, 1223 subjects were followed-up for a median period of 6years (IQR: 4-10), and 34 (2.8%) developed AF. Baseline CHADS (OR: 1.71; 95% CI: 1.28-2.29, p<0.001) and CHADS-VASc scores (OR: 1.56; 95% CI: 1.26-1.92, p<0.001) as well as low HDL-C levels (OR: 3.79; 95% CI: 1.85-7.75, p<0.001) were significantly associated with new-onset AF. ROC curve analyses showed that both CHADS and CHADS-VASc scores were significant predictors for new-onset AF (C-Statistic: CHADS 0.679, p<0.001; CHADS-VASc 0.698, p<0.001). Higher CHADS scores were associated with reduced event-free survival from AF (log-rank=10.62, p=0.001) with differences potentiated if stratified by CHADS-VASc score (log-rank=22.29, p<0.001). After incorporating low HDL-C levels, both scores achieved slightly higher C-Statistic for AF prediction (0.690 and 0.707, respectively, p<0.001).
CHADS and CHADS-VASc scores predict new AF in dyslipidemic patients. Risk prediction improved modestly when low HDL-C levels were included.
探讨CHADS和CHADS-VASc评分在预测血脂异常个体发生心房颤动（AF）中的价值，并评估纳入低水平高密度脂蛋白胆固醇（HDL-C）的附加价值。
这项观察性研究纳入了1241名前往血脂门诊的个体。构建了包含临床和实验室参数的模型，以测试CHADS和CHADS-VASc评分以及低HDL-C水平对新发AF的预测价值。男性和女性受试者的低HDL-C水平分别定义为<40mg/dL和<50mg/dL。
排除18例基线时患有AF的患者后，对1223名受试者进行了中位时间为6年的随访（四分位间距：4 - 10年），34例（2.8%）发生了AF。基线CHADS评分（比值比：1.71；95%置信区间：1.28 - 2.29，p<0.001）、CHADS-VASc评分（比值比：1.56；95%置信区间：1.26 - 1.92，p<0.001）以及低HDL-C水平（比值比：3.79；95%置信区间：1.85 - 7.75，p<0.001）均与新发AF显著相关。ROC曲线分析表明，CHADS和CHADS-VASc评分均是新发AF的显著预测指标（C统计量：CHADS为0.679，p<0.001；CHADS-VASc为0.698，p<0.001）。较高的CHADS评分与AF无事件生存期缩短相关（对数秩检验=10.62，p=0.001），若按CHADS-VASc评分分层则差异更显著（对数秩检验=22.29，p<0.001）。纳入低HDL-C水平后，两个评分在预测AF时的C统计量均略有提高（分别为0.690和0.707，p<0.001）。
CHADS和CHADS-VASc评分可预测血脂异常患者发生新发AF。纳入低HDL-C水平时，风险预测略有改善。
