Schæffer Mie, Rasmussen Jeppe Holm, Fredgart Maise Høigaard, Hasific Selma, Jakobsen Frederikke Nørregaard, Steffensen Flemming Hald, Lambrechtsen Jess, Rønnow Sand Niels Peter, Rasmussen Lars Melholt, Diederichsen Axel Cp
Department of Cardiology, Odense University Hospital, Denmark.
Department of Cardiology, Sygehus Lillebælt Vejle, Vejle, Denmark.
Atheroscler Plus. 2024 Sep 24;58:9-15. doi: 10.1016/j.athplu.2024.09.003. eCollection 2024 Dec.
The SCORE2 algorithm is recommended to estimate risk of cardiovascular disease (CVD). Coronary artery calcification (CAC) score is expensive but improves the risk prediction. This study aims to determine and compare the additive value of CAC-score and 19 biomarkers in risk prediction.
Traditional cardiovascular (CV) risk factors, CAC-score, and a wide range of biomarkers (including lipids, calcium-phosphate metabolism, troponin, inflammation, kidney function and ankle brachial index (ABI)) were collected from 1211 randomly selected middle-aged men and women in this multicenter prospective cohort in 2009-2010. 10-year follow-up data on CV-events were obtained via the Danish Health Registries. CV-event was defined as stroke, myocardial infarction, hospitalization for heart failure, coronary artery revascularization or death from CVD. The association between SCORE2, CAC-score, biomarkers, and CV-events was assessed using cox proportional hazard rates (HR) and compared using AUC-calculation of ROC-curves. Finally, net reclassification improvement (NRI) was calculated.
92 participants had CV-events. Adjusted for risk factors, CAC-score was significantly associated with events (adjusted HR 1.9 (95%CI:1.1; 3.3), 3.6 (95%CI:1.9; 6.8), and 5. (95%CI:2.6; 10.3) for CAC-score 1-99, CAC-score 100-399 and CAC-score ≥400, respectively. HR for the highest quartile of CRP was 2.3 (95%CI:1.2; 4.5), while none of the remaining biomarkers improved HR. Adjusted for SCORE2, the CAC-score improved AUC (AUC: 0.72, AUC: 0.67, 0.01). A combination of selected biomarkers (total cholesterol, low-density lipoprotein, phosphate, troponin, CRP, and creatinine) borderline improved AUC (AUC: 0.71, AUC: 0.67, 0.06). NRI for CAC score was 63 % (0.0001).
CAC-score improved prediction of CV-events, however the selected biomarkers did not.
推荐使用SCORE2算法来评估心血管疾病（CVD）风险。冠状动脉钙化（CAC）评分虽成本高昂，但能改善风险预测。本研究旨在确定并比较CAC评分和19种生物标志物在风险预测中的附加价值。
于2009 - 2010年在这个多中心前瞻性队列研究中，从1211名随机选取的中年男性和女性中收集传统心血管（CV）危险因素、CAC评分以及一系列生物标志物（包括血脂、钙磷代谢、肌钙蛋白、炎症、肾功能和踝臂指数（ABI））。通过丹麦健康登记处获取关于CV事件的10年随访数据。CV事件定义为中风、心肌梗死、因心力衰竭住院、冠状动脉血运重建或死于CVD。使用Cox比例风险率（HR）评估SCORE2、CAC评分、生物标志物与CV事件之间的关联，并通过ROC曲线的AUC计算进行比较。最后，计算净重新分类改善（NRI）。
92名参与者发生了CV事件。在对危险因素进行调整后，CAC评分与事件显著相关（对于CAC评分1 - 99、CAC评分100 - 399和CAC评分≥400，调整后的HR分别为1.9（95%CI：1.1；3.3）、3.6（95%CI：1.9；6.8）和5.（95%CI：2.6；10.3））。CRP最高四分位数的HR为2.3（95%CI：1.2；4.5），而其余生物标志物均未改善HR。在对SCORE2进行调整后，CAC评分改善了AUC（AUC：0.72，AUC：0.67，差值0.01）。选定生物标志物（总胆固醇、低密度脂蛋白、磷酸盐、肌钙蛋白、CRP和肌酐）的组合使AUC有边缘性改善（AUC：0.71，AUC：0.67，差值0.06）。CAC评分的NRI为63%（P = 0.0001）。
CAC评分改善了对CV事件的预测，然而选定的生物标志物并未做到。
