Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Institute of Biomedical Engineering, University of Oxford, Oxford, UK.
Heart. 2023 Oct 26;109(22):1690-1697. doi: 10.1136/heartjnl-2022-321231.
To externally evaluate the performance of QRISK3 for predicting 10 year risk of cardiovascular disease (CVD) in the UK Biobank cohort.
We used data from the UK Biobank, a large-scale prospective cohort study of 403 370 participants aged 40-69 years recruited between 2006 and 2010 in the UK. We included participants with no previous history of CVD or statin treatment and defined the outcome to be the first occurrence of coronary heart disease, ischaemic stroke or transient ischaemic attack, derived from linked hospital inpatient records and death registrations.
Our study population included 233 233 women and 170 137 men, with 9295 and 13 028 incident CVD events, respectively. Overall, QRISK3 had moderate discrimination for UK Biobank participants (Harrell's C-statistic 0.722 in women and 0.697 in men) and discrimination declined by age (<0.62 in all participants aged 65 years or older). QRISK3 systematically overpredicted CVD risk in UK Biobank, particularly in older participants, by as much as 20%.
QRISK3 had moderate overall discrimination in UK Biobank, which was best in younger participants. The observed CVD risk for UK Biobank participants was lower than that predicted by QRISK3, particularly for older participants. It may be necessary to recalibrate QRISK3 or use an alternate model in studies that require accurate CVD risk prediction in UK Biobank.
在英国生物库队列中对外评估 QRISK3 预测 10 年心血管疾病（CVD）风险的性能。
我们使用了来自英国生物库的资料，这是一项针对 403370 名年龄在 40-69 岁之间的参与者的大型前瞻性队列研究，于 2006 年至 2010 年在英国招募。我们纳入了没有 CVD 既往史或他汀类药物治疗史的参与者，并将首次发生的冠心病、缺血性卒中和短暂性脑缺血发作定义为结局，来源于相关的医院住院记录和死亡登记。
我们的研究人群包括 233233 名女性和 170137 名男性，分别有 9295 例和 13028 例 CVD 事件。总体而言，QRISK3 对英国生物库参与者具有中等的判别能力（女性的 Harrell C 统计量为 0.722，男性为 0.697），且判别能力随年龄下降（所有 65 岁及以上的参与者均<0.62）。QRISK3 系统地高估了英国生物库参与者的 CVD 风险，尤其是在年龄较大的参与者中，高估幅度高达 20%。
QRISK3 在英国生物库中的总体判别能力中等，在年轻参与者中最佳。英国生物库参与者的观察到的 CVD 风险低于 QRISK3 预测的风险，尤其是在年龄较大的参与者中。在需要在英国生物库中准确预测 CVD 风险的研究中，可能需要重新校准 QRISK3 或使用替代模型。
