Azcui Aparicio Roberto Enrique, Carrington Melinda J, Huynh Quan, Ball Jocasta, Marwick Thomas H
Baker Heart and Diabetes Institute, Melbourne, Australia.
Torrens University Australia, Melbourne, Australia.
Cardiovasc Digit Health J. 2023 May 4;4(3):91-100. doi: 10.1016/j.cvdhj.2023.04.004. eCollection 2023 Jun.
The requirement for laboratory tests to assess conventional cardiovascular disease (CVD) risk may be a barrier to the early detection and management of atherosclerosis in some population groups. A simpler risk assessment could facilitate detection of CVD.
The association of the Fuster-BEWAT Score (FBS), Framingham Risk Score (FRS), and Pooled Cohort Equation (PCE) with the presence of carotid plaque was investigated, with the intention of developing a stepped screening process for the primary prevention of CVD.
Asymptomatic participants with a family history of premature CVD had an absolute cardiovascular disease risk (ACVDR) score calculated using the FBS, FRS, and PCE risk equations. This risk classification was compared with the presence or absence of carotid plaque on ultrasound. Prediction of carotid plaque presence by risk scores and risk factors was assessed by logistic regression and area under the curve (AUC) for discrimination and diagnostic performance. A classification and regression-tree (CART) model was obtained for stratification of risk assessment.
Risk score calculation and ultrasound scanning were performed in 1031 participants, of whom 51 had carotid plaques. Participants with plaque and male sex showed higher risk (higher PCE and FRS and lower FBS, as higher scores of FBS indicate better cardiovascular health). Participants ≤50 years of age showed the FBS was a significant predictor; there was a reduced likelihood of plaque presence with a higher score (OR 0.54, 95% CI 0.39-0.75, < .01). Higher ACVDR (evidenced by higher PCE and FRS scores and lower FBS score) was associated with an increased likelihood of carotid plaque; however, the FBS and the addition of risk factors not included in the equation showed the highest AUC (AUC = 0.76, < .001). CART modeling showed that participants with FBS between 6 and 9 would be recommended for further risk stratification using the PCE, whereupon a PCE score ≥5% conferred an increased risk and greater possibility for plaque. Validation of the model using a different cohort showed similar risk stratification for plaque presence according to level of risk by CART analysis.
FBS was able to identify the presence of carotid plaque in asymptomatic individuals. Its use for initial risk delineation might improve the selection of patients for more specific and complex assessment, reducing cost and time.
在某些人群中，通过实验室检查来评估传统心血管疾病（CVD）风险的要求可能会成为早期检测和管理动脉粥样硬化的障碍。一种更简单的风险评估方法可能有助于CVD的检测。
研究福斯特 - BEWAT评分（FBS）、弗雷明汉风险评分（FRS）和汇总队列方程（PCE）与颈动脉斑块存在情况之间的关联，旨在为CVD的一级预防制定一个逐步筛查流程。
有早发性CVD家族史的无症状参与者使用FBS、FRS和PCE风险方程计算绝对心血管疾病风险（ACVDR）评分。将这种风险分类与超声检查中颈动脉斑块的有无进行比较。通过逻辑回归和曲线下面积（AUC）评估风险评分和风险因素对颈动脉斑块存在情况的预测，以判断其鉴别能力和诊断性能。获得一个分类回归树（CART）模型用于风险评估分层。
对1031名参与者进行了风险评分计算和超声扫描，其中51人有颈动脉斑块。有斑块的参与者和男性显示出更高的风险（PCE和FRS更高，FBS更低，因为FBS得分越高表明心血管健康状况越好）。年龄≤50岁的参与者中，FBS是一个显著的预测指标；得分越高，出现斑块的可能性越低（OR 0.54，95%CI 0.39 - 0.75，P <.01）。较高的ACVDR（以较高的PCE和FRS得分以及较低的FBS得分证明）与颈动脉斑块出现的可能性增加相关；然而，FBS以及方程中未包含的风险因素的加入显示出最高的AUC（AUC = 0.76，P <.001）。CART建模显示，FBS在6到9之间的参与者建议使用PCE进行进一步的风险分层，此时PCE评分≥5%表明风险增加且出现斑块的可能性更大。使用不同队列对模型进行验证，根据CART分析的风险水平，显示出斑块存在情况的风险分层相似。
FBS能够识别无症状个体中颈动脉斑块的存在。将其用于初始风险划分可能会改善对患者进行更具体和复杂评估时的选择，降低成本和时间。
