自我报告的中风风险分层：中风研究中地理和种族差异的原因
Self-Reported Stroke Risk Stratification: Reasons for Geographic and Racial Differences in Stroke Study.
作者信息
Howard George, McClure Leslie A, Moy Claudia S, Howard Virginia J, Judd Suzanne E, Yuan Ya, Long D Leann, Muntner Paul, Safford Monika M, Kleindorfer Dawn O
机构信息
From the Departments of Biostatistics (G.H., S.E.J., Y.Y., D.L.L.) and Epidemiology (V.J.H., P.M.), School of Public Health, University of Alabama at Birmingham; Department of Biostatistics and Epidemiology, Drexel University, Philadelphia, PA (L.A.M.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.S.M.); Division of General Internal Medicine, Cornell School of Medicine, New York, NY (M.M.S.); and Department of Neurology, University of Cincinnati, OH (D.O.K.).
出版信息
Stroke. 2017 Jul;48(7):1737-1743. doi: 10.1161/STROKEAHA.117.016757. Epub 2017 May 19.
BACKGROUND AND PURPOSE
The standard for stroke risk stratification is the Framingham Stroke Risk Function (FSRF), an equation requiring an examination for blood pressure assessment, venipuncture for glucose assessment, and ECG to determine atrial fibrillation and heart disease. We assess a self-reported stroke risk function (SRSRF) to stratify stroke risk in comparison to the FSRF.
METHODS
Participants from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) were evaluated at baseline and followed for incident stroke. The FSRF was calculated using directly assessed stroke risk factors. The SRSRF was calculated from 13 self-reported questions to exclude those with prevalent stroke and assess stroke risk. Proportional hazards analysis was used to assess incident stroke risk using the FSRF and SRSRF.
RESULTS
Over an average 8.2-year follow-up, 939 of 23 983 participants had a stroke. The FSRF and SRSRF produced highly correlated risk scores (=0.852; 95% confidence interval, 0.849-0.856); however, the SRSRF had higher discrimination of stroke risk than the FSRF (c=0.7266; 95% confidence interval, 0.7076-0.7457; c=0.7075; 95% confidence interval, 0.6877-0.7273; =0.0038). The 10-year stroke risk in the highest decile of predicted risk was 11.1% for the FSRF and 13.4% for the SRSRF.
CONCLUSIONS
A simple self-reported questionnaire can be used to identify those at high risk for stroke better than the gold standard FSRF. This instrument can be used clinically to easily identify individuals at high risk for stroke and also scientifically to identify a subpopulation enriched for stroke risk.
背景与目的
中风风险分层的标准是弗雷明汉姆中风风险函数（FSRF），这是一个需要进行血压评估检查、静脉穿刺进行血糖评估以及心电图检查以确定房颤和心脏病的方程。我们评估一种自我报告的中风风险函数（SRSRF），并与FSRF比较以对中风风险进行分层。
方法
对来自REGARDS研究（中风地理和种族差异原因研究）的参与者在基线时进行评估，并随访其发生中风的情况。FSRF使用直接评估的中风风险因素来计算。SRSRF通过13个自我报告问题来计算，以排除那些患有中风的患者并评估中风风险。使用比例风险分析来评估使用FSRF和SRSRF的中风发病风险。
结果
在平均8.2年的随访期内，23983名参与者中有939人发生了中风。FSRF和SRSRF产生的风险评分高度相关（=0.852；95%置信区间，0.849 - 0.856）；然而，SRSRF对中风风险的辨别能力高于FSRF（c = 0.7266；95%置信区间，0.7076 - 0.7457；c = 0.7075；95%置信区间，0.6877 - 0.7273；=0.0038）。预测风险最高十分位数人群的10年中风风险，FSRF为11.1%，SRSRF为13.4%。
结论
一份简单的自我报告问卷可用于比金标准FSRF更好地识别中风高危人群。该工具可在临床上用于轻松识别中风高危个体，也可在科学上用于识别中风风险富集的亚人群。
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