弗雷明汉风险评分和队列研究方程的校准和判别。
Calibration and discrimination of the Framingham Risk Score and the Pooled Cohort Equations.
机构信息
Schulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta.
出版信息
CMAJ. 2020 Apr 27;192(17):E442-E449. doi: 10.1503/cmaj.190848.
BACKGROUND
Although accurate risk prediction is essential in guiding treatment decisions in primary prevention of atherosclerotic cardiovascular disease, the accuracy of the Framingham Risk Score (recommended by a Canadian guideline) and the Pooled Cohort Equations (recommended by US guidelines) has not been assessed in a large contemporary Canadian population. Our primary objective was to assess the calibration and discrimination of the Framingham Risk Score and Pooled Cohort Equations in Ontario, Canada.
METHODS
We conducted an observational study involving Ontario residents aged 40 to 79 years, without a history of atherosclerotic cardiovascular disease, who underwent cholesterol testing and blood pressure measurement from Jan. 1, 2010, to Dec. 31, 2014. We compared predicted event rates generated by the Framingham Risk Score and the Pooled Cohort Equations with observed event rates at 5 years using linkages from validated administrative databases.
RESULTS
Our study cohort included 84 617 individuals (mean age 56.3 yr, 56.9% female). Over a maximum follow-up period of 5 years, we observed 2162 (2.6%) events according to the outcome definition of the Framingham Risk Score, and 1224 (1.4%) events according to the outcome definition of the Pooled Cohort Equations. The predicted event rate of 5.78% by the Framingham Risk Score and 3.51% by the Pooled Cohort Equations at 5 years overestimated observed event rates by 101% and 115%, respectively. The degree of overestimation differed by age and ethnicity. The C statistics for the Framingham Risk Score (0.74) and Pooled Cohort Equations (0.73) were similar.
INTERPRETATION
The Framingham Risk Score and Pooled Cohort Equations significantly overpredicted the actual risks of atherosclerotic cardiovascular disease events in a large population from Ontario. Our finding suggests the need for further refinement of cardiovascular disease risk prediction scores to suit the characteristics of a multiethnic Canadian population.
背景
尽管准确的风险预测对于指导动脉粥样硬化性心血管疾病一级预防的治疗决策至关重要，但 Framingham 风险评分（加拿大指南推荐）和 Pooled Cohort Equations（美国指南推荐）在大型当代加拿大人群中的准确性尚未得到评估。我们的主要目标是评估 Framingham 风险评分和 Pooled Cohort Equations 在安大略省的校准和区分能力。
方法
我们进行了一项观察性研究，纳入了 2010 年 1 月 1 日至 2014 年 12 月 31 日期间接受胆固醇检测和血压测量的年龄在 40 至 79 岁、无动脉粥样硬化性心血管疾病史的安大略省居民。我们使用验证后的行政数据库的链接，比较了 Framingham 风险评分和 Pooled Cohort Equations 预测的 5 年事件发生率与观察到的事件发生率。
结果
我们的研究队列包括 84617 人（平均年龄 56.3 岁，56.9%为女性）。在最长 5 年的随访期间，根据 Framingham 风险评分的结局定义，我们观察到 2162 例（2.6%）事件，根据 Pooled Cohort Equations 的结局定义，我们观察到 1224 例（1.4%）事件。Framingham 风险评分预测的 5 年 5.78%的事件发生率和 Pooled Cohort Equations 预测的 3.51%的事件发生率分别高估了观察到的事件发生率 101%和 115%。高估的程度因年龄和种族而异。Framingham 风险评分的 C 统计量（0.74）和 Pooled Cohort Equations（0.73）相似。
解释
Framingham 风险评分和 Pooled Cohort Equations 显著高估了安大略省一个大型人群发生动脉粥样硬化性心血管疾病事件的实际风险。我们的发现表明，需要进一步改进心血管疾病风险预测评分，以适应多民族加拿大人群的特点。
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