将种族因素纳入心血管疾病风险预测：利用HELIUS人群队列数据对SCORE2进行外部验证和模型更新

Adding ethnicity to cardiovascular risk prediction: External validation and model updating of SCORE2 using data from the HELIUS population cohort.

作者信息

van Apeldoorn Joshua A N, Hageman Steven H J, Harskamp Ralf E, Agyemang Charles, van den Born Bert-Jan H, van Dalen Jan Willem, Galenkamp Henrike, Hoevenaar-Blom Marieke P, Richard Edo, van Valkengoed Irene G M, Visseren Frank L J, Dorresteijn Jannick A N, Moll van Charante Eric P

机构信息

Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands; Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.

出版信息

Int J Cardiol. 2024 Dec 15;417:132525. doi: 10.1016/j.ijcard.2024.132525. Epub 2024 Sep 5.

DOI:10.1016/j.ijcard.2024.132525

PMID:39244095

Abstract

BACKGROUND

Current prediction models for mainland Europe do not include ethnicity, despite ethnic disparities in cardiovascular disease (CVD) risk. SCORE2 performance was evaluated across the largest ethnic groups in the Netherlands and ethnic backgrounds were added to the model.

METHODS

11,614 participants, aged between 40 and 70 years without CVD, from the population-based multi-ethnic HELIUS study were included. Fine and Gray models were used to calculate sub-distribution hazard ratios (SHR) for South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin groups, representing their CVD risk relative to the Dutch group, on top of individual SCORE2 risk predictions. Model performance was evaluated by discrimination, calibration and net reclassification index (NRI).

RESULTS

Overall, 274 fatal and non-fatal CVD events, and 146 non-cardiovascular deaths were observed during a median of 7.8 years follow-up (IQR 6.8-8.8). SHRs for CVD events were 1.86 (95 % CI 1.31-2.65) for the South-Asian Surinamese, 1.09 (95 % CI 0.76-1.56) for the African-Surinamese, 1.48 (95 % CI 0.94-2.31) for the Ghanaian, 1.63 (95 % CI 1.09-2.44) for the Turkish, and 0.67 (95 % CI 0.39-1.18) for the Moroccan origin groups. Adding ethnicity to SCORE2 yielded comparable calibration and discrimination [0.764 (95 % CI 0.735-0.792) vs. 0.769 (95 % CI 0.740-0.797)]. The NRI for adding ethnicity to SCORE2 was 0.24 (95 % CI 0.18-0.31) for events and - 0.12 (95 % CI -0.13-0.12) for non-events.

CONCLUSIONS

Adding ethnicity to the SCORE2 risk prediction model in a middle-aged, multi-ethnic Dutch population did not improve overall discrimination but improved risk classification, potentially helping to address CVD disparities through timely treatment.

摘要

背景

尽管心血管疾病（CVD）风险存在种族差异，但目前欧洲大陆的预测模型并未纳入种族因素。对荷兰最大的几个种族群体评估了SCORE2模型的性能，并将种族背景纳入该模型。

方法

纳入了基于人群的多民族HELIUS研究中的11614名年龄在40至70岁之间且无CVD的参与者。使用Fine和Gray模型计算南亚苏里南人、非洲苏里南人、加纳人、土耳其人和摩洛哥人起源群体的亚分布风险比（SHR），以表示他们相对于荷兰群体的CVD风险，这是在个体SCORE2风险预测之上进行的。通过区分度、校准和净重新分类指数（NRI）评估模型性能。

结果

在中位7.8年的随访期间（四分位间距6.8 - 8.8），共观察到274例致命和非致命的CVD事件以及146例非心血管死亡。南亚苏里南人CVD事件的SHR为1.86（95%置信区间1.31 - 2.65），非洲苏里南人为1.09（95%置信区间0.76 - 1.56），加纳人为1.48（95%置信区间0.94 - 2.31），土耳其人为1.63（95%置信区间1.09 - 2.44），摩洛哥人起源群体为0.67（95%置信区间0.39 - 1.18）。将种族因素添加到SCORE2模型中产生了相当的校准和区分度[0.764（95%置信区间0.735 - 0.792）对0.769（95%置信区间0.740 - 0.797）]。将种族因素添加到SCORE2模型中的事件NRI为0.24（95%置信区间0.18 - 0.31），非事件NRI为 - 0.12（95%置信区间 - 0.13 - 0.12）。