基于一项前瞻性队列研究结果，验证世界卫生组织/国际高血压学会（WHO/ISH）在斯里兰卡人群中的心血管风险预测模型。
Validation of the World Health Organization/ International Society of Hypertension (WHO/ISH) cardiovascular risk predictions in Sri Lankans based on findings from a prospective cohort study.
机构信息
Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
出版信息
PLoS One. 2021 Jun 7;16(6):e0252267. doi: 10.1371/journal.pone.0252267. eCollection 2021.
INTRODUCTION AND OBJECTIVES
There are no cardiovascular (CV) risk prediction models for Sri Lankans. Different risk prediction models not validated for Sri Lankans are being used to predict CV risk of Sri Lankans. We validated the WHO/ISH (SEAR-B) risk prediction charts prospectively in a population-based cohort of Sri Lankans.
METHOD
We selected 40-64 year-old participants from the Ragama Medical Officer of Health (MOH) area in 2007 by stratified random sampling and followed them up for 10 years. Ten-year risk predictions of a fatal/non-fatal cardiovascular event (CVE) in 2007 were calculated using WHO/ISH (SEAR-B) charts with and without cholesterol. The CVEs that occurred from 2007-2017 were ascertained. Risk predictions in 2007 were validated against observed CVEs in 2017.
RESULTS
Of 2517 participants, the mean age was 53.7 year (SD: 6.7) and 1132 (45%) were males. Using WHO/ISH chart with cholesterol, the percentages of subjects with a 10-year CV risk <10%, 10-19%, 20%-29%, 30-39%, ≥40% were 80.7%, 9.9%, 3.8%, 2.5% and 3.1%, respectively. 142 non-fatal and 73 fatal CVEs were observed during follow-up. Among the cohort, 9.4% were predicted of having a CV risk ≥20% and 8.6% CVEs were observed in the risk category. CVEs were within the predictions of WHO/ISH charts with and without cholesterol in both high (≥20%) and low(<20%) risk males, but only in low(<20%) risk females. The predictions of WHO/ISH charts, with-and without-cholesterol were in agreement in 81% of subjects (ĸ = 0.429; p<0.001).
CONCLUSIONS
WHO/ISH (SEAR B) risk prediction charts with-and without-cholesterol may be used in Sri Lanka. Risk charts are more predictive in males than in females and for lower-risk categories. The predictions when stratifying into 2 categories, low risk (<20%) and high risk (≥20%), are more appropriate in clinical practice.
简介和目的
目前尚无针对斯里兰卡人的心血管（CV）风险预测模型。不同的风险预测模型未经斯里兰卡验证，目前正被用于预测斯里兰卡人的 CV 风险。我们前瞻性地验证了基于人群的斯里兰卡队列中世卫组织/ISH（东南亚和西太平洋地区）风险预测图。
方法
我们于 2007 年通过分层随机抽样从拉嘎马医疗官地区（MOH）选择了 40-64 岁的参与者，并对其进行了 10 年的随访。2007 年使用世卫组织/ISH（东南亚和西太平洋地区）图表（包括和不包括胆固醇）计算了致命/非致命心血管事件（CVE）的 10 年风险预测。2007 年至 2017 年期间发生的 CVEs 进行了确定。2007 年的风险预测与 2017 年的观察性 CVEs 进行了验证。
结果
在 2517 名参与者中，平均年龄为 53.7 岁（SD：6.7），1132 名（45%）为男性。使用包含胆固醇的世卫组织/ISH 图表，10 年 CV 风险<10%、10-19%、20%-29%、30-39%、≥40%的受试者比例分别为 80.7%、9.9%、3.8%、2.5%和 3.1%。随访期间观察到 142 例非致命和 73 例致命 CVEs。该队列中，有 9.4%的人被预测 CV 风险≥20%，有 8.6%的人在风险类别中观察到 CVEs。在高（≥20%）和低（<20%）风险男性中，世卫组织/ISH 图表（包含和不包含胆固醇）的预测值与 CVEs 相符，但仅在低（<20%）风险女性中相符。在 81%的受试者中，世卫组织/ISH 图表（包含和不包含胆固醇）的预测值一致（ĸ=0.429；p<0.001）。
结论
世卫组织/ISH（东南亚和西太平洋地区）有或无胆固醇的风险预测图表可用于斯里兰卡。风险图表在男性中的预测性优于女性，在低风险类别中预测性更好。在分为低风险（<20%）和高风险（≥20%）两类时，预测更为合适。
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