Ungprasert Patompong, Matteson Eric L, Crowson Cynthia S
Division of Rheumatology, Department of Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Rheumatology, Department of Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.
Am J Cardiol. 2017 Sep 1;120(5):868-873. doi: 10.1016/j.amjcard.2017.05.060. Epub 2017 Jun 15.
Chronic inflammation is an independent risk factor for cardiovascular disease (CVD), but most risk calculators, including the Framingham risk score (FRS) and the American College of Cardiology (ACC)/American Heart Association (AHA) risk score do not account for it. These calculators underestimate cardiovascular risk in patients with rheumatoid arthritis and systemic lupus erythematosus. To date, how these scores perform in the estimation of CVD risk in patients with sarcoidosis has not been assessed. In this study, the FRS and the ACC/AHA risk score were calculated for a previously identified cohort of patients with incident cases of sarcoidosis in Olmsted County, Minnesota, United States, from 1989 to 2013 as well as their gender- and age-matched comparators. The standardized incidence ratio (SIR) was estimated as the ratio of the predicted and observed numbers of CVD events. All CVD events were identified by diagnosis codes and were verified by individual medical record reviews. The predicted number of CVD events among 188 cases by FRS was 11.8 and the observed number of CVD events was 34, which corresponded to an SIR of 2.88 (95% confidence interval 2.06 to 4.04). FRS underestimated the risk of CVD events in patients with sarcoidosis by gender, age and severity of sarcoidosis. The predicted number of CVD events among cases by ACC/AHA risk score was 4.6 and the observed number of CVD events was 19, corresponding to an SIR of 4.11 (95% confidence interval 2.62 to 6.44). In conclusion, the FRS and the ACC/AHA risk score underestimate the risk of CVD in patients with sarcoidosis.
慢性炎症是心血管疾病（CVD）的独立危险因素，但包括弗雷明汉风险评分（FRS）和美国心脏病学会（ACC）/美国心脏协会（AHA）风险评分在内的大多数风险计算器都未将其考虑在内。这些计算器低估了类风湿性关节炎和系统性红斑狼疮患者的心血管风险。迄今为止，这些评分在结节病患者心血管疾病风险评估中的表现尚未得到评估。在本研究中，对美国明尼苏达州奥尔姆斯特德县1989年至2013年期间先前确定的一组结节病新发病例患者及其性别和年龄匹配的对照者计算了FRS和ACC/AHA风险评分。标准化发病比（SIR）估计为预测的和观察到的心血管疾病事件数量之比。所有心血管疾病事件均通过诊断代码识别，并经个人病历审查核实。FRS预测188例患者中的心血管疾病事件数量为11.8，观察到的心血管疾病事件数量为34，对应的SIR为2.88（95%置信区间2.06至4.04）。FRS按性别、年龄和结节病严重程度低估了结节病患者心血管疾病事件的风险。ACC/AHA风险评分预测病例中的心血管疾病事件数量为4.6，观察到的心血管疾病事件数量为19，对应的SIR为4.11（95%置信区间2.62至6.44）。总之，FRS和ACC/AHA风险评分低估了结节病患者的心血管疾病风险。
