Mewborn Emily K, Tolley Elizabeth A, Wright David B, Doneen Amy L, Stanfill Ansley G
School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA.
Clin Nurs Res. 2025 May;34(3-4):160-167. doi: 10.1177/10547738241305784. Epub 2025 Jan 4.
Atherosclerotic cardiovascular disease (ASCVD) risk calculators estimate the 10-year incident risk of myocardial infarction (MI), coronary artery disease (CAD) death, or stroke; however, they lack comprehensiveness and accuracy. Carotid intima-media thickness (CIMT) is a surrogate marker that may improve risk estimation acumen. The objective of this study was to derive ASCVD risk scores from historical data and determine whether these risk scores are associated with the history of subclinical CAD and CIMT. This retrospective cross-sectional study used an existing dataset of individuals with prediabetes. Subclinical CAD history was defined as the history of CAD, coronary plaque, or coronary revascularization without a history of MI. The online ASCVD Risk Estimator Plus calculator was used to derive individual risk scores. Chi-square or Fisher's exact tests for categorical variables and ANOVA for continuous variables detected differences among ASCVD risk categories. Linear regression of CIMT measurements on ASCVD risk scores ascertained ASCVD risk scores' utility in predicting CIMT measurements. The sample included 86 participants, 28% with a history of CAD, 60% male, and 95% White. No differences in risk scores existed between participants with or without CAD. Individuals with higher ASCVD risk scores were older ( ≤ .001) and had higher systolic blood pressure ( ≤ .001), CIMT arterial age ( = .003), mean IMT common ( ≤ .001), mean IMT maximum ( ≤ .001), and plaque burden ( = .02) measurements. ASCVD risk scores were significantly associated and moderately correlated with CIMT measurements. ASCVD risk scores were not associated with CAD history but were associated with CIMT measurements. While risk calculators provide a starting point for ASCVD risk estimation, physical tools like CIMT can diagnose ASCVD, categorize plaque quality, and track intervention efficacy. CIMT may be used for more direct ASCVD risk estimation. Risk scores are easily imputed from existing records but are only intended for incident risk, and their accuracy relies on the variables' availability and validity and the boundaries of the calculators.
动脉粥样硬化性心血管疾病（ASCVD）风险计算器可估算心肌梗死（MI）、冠状动脉疾病（CAD）死亡或中风的10年发病风险；然而，它们缺乏全面性和准确性。颈动脉内膜中层厚度（CIMT）是一种替代标志物，可能会提高风险评估的敏锐度。本研究的目的是从历史数据中得出ASCVD风险评分，并确定这些风险评分是否与亚临床CAD病史和CIMT相关。这项回顾性横断面研究使用了现有的糖尿病前期个体数据集。亚临床CAD病史定义为无MI病史的CAD、冠状动脉斑块或冠状动脉血运重建病史。使用在线ASCVD风险评估器升级版计算器得出个体风险评分。对分类变量采用卡方检验或Fisher精确检验，对连续变量采用方差分析来检测ASCVD风险类别之间的差异。CIMT测量值对ASCVD风险评分的线性回归确定了ASCVD风险评分在预测CIMT测量值方面的效用。样本包括86名参与者，28%有CAD病史，60%为男性，95%为白人。有或无CAD的参与者之间风险评分无差异。ASCVD风险评分较高的个体年龄较大（P≤0.001），收缩压较高（P≤0.001），CIMT动脉年龄较大（P = 0.003），平均IMT平均值较高（P≤0.001），平均IMT最大值较高（P≤0.001），斑块负荷较高（P = 0.02）。ASCVD风险评分与CIMT测量值显著相关且呈中度相关。ASCVD风险评分与CAD病史无关，但与CIMT测量值相关。虽然风险计算器为ASCVD风险评估提供了一个起点，但像CIMT这样的物理工具可以诊断ASCVD、对斑块质量进行分类并跟踪干预效果。CIMT可用于更直接的ASCVD风险评估。风险评分可轻松从现有记录中推算得出，但仅用于发病风险评估，其准确性依赖于变量的可用性和有效性以及计算器的范围。
