Kozakova Michaela, Morizzo Carmela, Jamagidze Giuli, Chiappino Dante, Palombo Carlo
Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy.
Esaote SpA, 16152 Genova, Italy.
J Clin Med. 2022 Aug 22;11(16):4931. doi: 10.3390/jcm11164931.
The concept of vascular age (VA) was proposed to provide patients with an understandable explanation of cardiovascular (CV) risk and to improve the performance of prediction models. The present study compared risk-based VA derived from Framingham Risk Score (FRS) and Systematic Coronary Risk Estimation (SCORE) models with value-based VA derived from the measurement of the common carotid artery (CCA) distensibility coefficient (DC), and it assessed the impact of DC-based VA on risk reclassification. In 528 middle-aged individuals apparently free of CV disease, DC was measured by radiofrequency-based arterial wall tracking that was previously utilised to establish sex- and age-specific reference values in a healthy population. DC-based VA represented the median value (50th percentile) for given sex in the reference population. FRS-based and SCORE-based VA was calculated as recommended. We observed a good agreement between DC-based and FRS-based VA, with a mean difference of 0.46 ± 12.2 years (p = 0.29), while the mean difference between DC-based and SCORE-based VA was higher (3.07 ± 12.7 years, p < 0.0001). When only nondiabetic individuals free of antihypertensive therapy were considered (n = 341), the mean difference dropped to 0.70 ± 12.8 years (p = 0.24). Substitution of chronological age with DC-based VA in FRS and SCORE models led to a reclassification of 28% and 49% of individuals, respectively, to the higher risk category. Our data suggest that the SCORE prediction model, in which diabetes and antihypertensive treatment are not considered, should be used as a screening tool only in healthy individuals. The use of VA derived from CCA distensibility measurements could improve the performance of risk prediction models, even that of the FRS model, as it might integrate risk prediction with additional risk factors participating in vascular ageing, unique to each individual. Prospective studies are needed to validate the role of DC-based VA in risk prediction.
血管年龄（VA）的概念被提出来，旨在为患者提供关于心血管（CV）风险的易懂解释，并提高预测模型的性能。本研究将基于弗雷明汉风险评分（FRS）和系统性冠状动脉风险评估（SCORE）模型得出的基于风险的VA与通过测量颈总动脉（CCA）扩张系数（DC）得出的基于价值的VA进行了比较，并评估了基于DC的VA对风险重新分类的影响。在528名明显无CV疾病的中年个体中，通过基于射频的动脉壁追踪测量DC，该方法先前曾用于在健康人群中建立性别和年龄特异性参考值。基于DC的VA代表参考人群中给定性别的中位数（第50百分位数）。基于FRS和基于SCORE的VA按推荐方法计算。我们观察到基于DC的VA和基于FRS的VA之间具有良好的一致性，平均差异为0.46±12.2岁（p = 0.29），而基于DC的VA和基于SCORE的VA之间的平均差异更高（3.07±12.7岁，p < 0.0001）。当仅考虑未接受抗高血压治疗的非糖尿病个体时（n = 341），平均差异降至0.70±12.8岁（p = 0.24）。在FRS和SCORE模型中用基于DC的VA替代实际年龄分别导致28%和49%的个体重新分类到更高风险类别。我们的数据表明，未考虑糖尿病和抗高血压治疗的SCORE预测模型仅应用于健康个体作为筛查工具。使用从CCA扩张性测量得出的VA可以改善风险预测模型的性能，甚至FRS模型的性能，因为它可能将风险预测与参与血管老化的其他风险因素整合在一起，这些因素因人而异。需要进行前瞻性研究来验证基于DC的VA在风险预测中的作用。
