Brotons Carlos, Moral Irene, Fernández Diana, Puig Mireia, Calvo Bonacho Eva, Martínez Muñoz Paloma, Catalina Romero Carlos, Quevedo Aguado Luis Javier
Unidad de Investigación, Equipo de Atención Primaria Sardenya, Instituto de Investigación Biomédica Sant Pau (IIB-Sant Pau), Barcelona, Spain; Unidad Docente ACEBA, Barcelona, Spain.
Unidad de Investigación, Equipo de Atención Primaria Sardenya, Instituto de Investigación Biomédica Sant Pau (IIB-Sant Pau), Barcelona, Spain; Unidad Docente ACEBA, Barcelona, Spain.
Rev Esp Cardiol (Engl Ed). 2019 Jul;72(7):562-568. doi: 10.1016/j.rec.2018.05.028. Epub 2018 Aug 7.
To develop a predictive function of lifetime cardiovascular risk, including morbidity and mortality, in a healthy working population in Spain.
Retrospective cohort study. We selected healthy workers, aged 18 to 65 years, with no history of cardiovascular disease, who underwent a health assessment between 2004 and 2007. We used 70% of the cohort to develop the risk equation, and the remaining 30% to validate the equation. Four Cox proportional hazards models were constructed using cardiovascular events and competing events as dependent variables. The same models were replicated for men and women separately. Fatal and nonfatal events were assessed until 2014.
A total of 762 054 individuals were selected. The mean age was 35.48 years and 71.14% were men. Significant risk variables in the model included manual occupations, being a smoker or exsmoker, diabetes mellitus, antihypertensive treatment, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, and lipid-lowering treatment; in men, the model also included alcohol consumption, body mass index, a family history of early coronary disease in first-degree relatives, renal failure, and diastolic blood pressure. The area under the curve receiver operating characteristic was 0.84 (95%CI, 0.82-0.85) in men and 0.73 (95%CI, 0.66-0.80) in women. Calibration showed underestimation in low-risk deciles and overestimation in high-risk deciles.
The new lifetime cardiovascular risk model has satisfactory discrimination and calibration, with better results in men than in women.
在西班牙健康工作人群中开发一种预测终生心血管疾病风险（包括发病率和死亡率）的功能。
回顾性队列研究。我们选取了年龄在18至65岁之间、无心血管疾病史且在2004年至2007年间接受健康评估的健康工作者。我们使用队列的70%来构建风险方程，其余30%用于验证该方程。构建了四个以心血管事件和竞争事件作为因变量的Cox比例风险模型。分别针对男性和女性复制相同的模型。评估截至2014年的致命和非致命事件。
共选取了762054名个体。平均年龄为35.48岁，男性占71.14%。模型中的显著风险变量包括体力劳动职业、吸烟者或曾经吸烟者、糖尿病、抗高血压治疗、收缩压、总胆固醇、高密度脂蛋白胆固醇和降脂治疗；在男性中，模型还包括饮酒、体重指数、一级亲属早发冠心病家族史、肾衰竭和舒张压。男性的受试者工作特征曲线下面积为0.84（95%CI，0.82 - 0.85），女性为0.73（95%CI，0.66 - 0.80）。校准显示在低风险十分位数中存在低估，在高风险十分位数中存在高估。
新的终生心血管疾病风险模型具有令人满意的区分度和校准度，男性的结果优于女性。
