美国心脏协会预防心血管风险方程在老年人中的表现。
Performance of the American Heart Association PREVENT Cardiovascular Risk Equations in Older Adults.
作者信息
Fravel Michelle A, Ernst Michael E, Woods Robyn L, Orchard Suzanne G, Ganjali Shiva, Wetmore James B, Reid Christopher, Ryan Joanne, Polkinghorne Kevan R, Wolfe Rory, Nelson Mark R, Zoungas Sophia, Zhou Zhen
机构信息
Department of Pharmacy Practice and Science, College of Pharmacy (M.A.F., M.E.E.), The University of Iowa.
Department of Family Medicine, Carver College of Medicine (M.E.E.), The University of Iowa.
出版信息
Circ Cardiovasc Qual Outcomes. 2025 Jun;18(6):e011719. doi: 10.1161/CIRCOUTCOMES.124.011719. Epub 2025 Apr 28.
BACKGROUND
The ability of the American Heart Association Predicting Risk of Cardiovascular Disease Events (PREVENT) calculator to accurately assign 10-year atherosclerotic cardiovascular disease (ASCVD) risk in older individuals, including those aged ≥80 years, is unknown. This study compares PREVENT with the 2013 Pooled Cohort Equation (PCE) calculator for predicting 10-year ASCVD risk in a large cohort of older adults.
METHODS
This was a prospective cohort study of adults without CVD from Australia and the United States aged ≥70 years (≥65 years, if US minorities). They were enrolled from 2010 to 2014 in the ASPREE trial (Aspirin in Reducing Events in the Elderly), a 5-year randomized trial of low-dose aspirin in community-dwelling older adults with posttrial observational follow-up extending to 2022. ASCVD events were adjudicated by expert panels. The discriminative ability of the 2 risk calculators was assessed by Harell C statistic following Cox regression in the 65- to 79-year age group and >80-year age group, separately. For calibration, predicted event numbers were calculated using PREVENT and PCE, scaled for the actual length of follow-up, and compared with the number of observed events in-trial and during extended follow-up.
RESULTS
Among the 15 510 participants aged 65 to 79 years (median age, 73.2 years; 56.1% women), 1084 ASCVD events occurred (median follow-up, 8.3 years); PCE predicted 3102 events while PREVENT predicted 1290 events. For the 2787 participants ≥80 years (median age, 82.6 years; 59.2% women), 355 ASCVD events occurred (median follow-up, 7.4 years); PCE predicted 1067 events while PREVENT predicted 350 events. PREVENT showed superior discriminative performance compared with PCE (PREVENT versus PCE, C statistic, 0.793 versus 0.740; <0.001 in participants aged 65 -79 years; 0.854 versus 0.799; <0.001 in those aged ≥80 years).
CONCLUSIONS
The PREVENT risk calculator is superior to the PCE calculator in predicting ASCVD events in older adults from the United States and Australia, including those aged ≥80 years.
REGISTRATION
URL: https://www.clinicaltrials.gov; Unique identifier: NCT01038583. URL: https://www.isrctn.com; Unique identifier: ISRCTN83772183.
背景
美国心脏协会心血管疾病事件预测（PREVENT）计算器在包括80岁及以上人群在内的老年人中准确评估10年动脉粥样硬化性心血管疾病（ASCVD）风险的能力尚不清楚。本研究比较了PREVENT与2013年合并队列方程（PCE）计算器在一大群老年人中预测10年ASCVD风险的情况。
方法
这是一项对来自澳大利亚和美国年龄≥70岁（如果是美国少数族裔则≥65岁）且无心血管疾病的成年人进行的前瞻性队列研究。他们于2010年至2014年入选阿司匹林减少老年人事件（ASPREE）试验，这是一项针对社区居住的老年人进行的低剂量阿司匹林为期5年的随机试验，试验后观察性随访延长至2022年。ASCVD事件由专家小组判定。分别在65至79岁年龄组和80岁以上年龄组中，通过Cox回归后的Harell C统计量评估这两种风险计算器的判别能力。为进行校准，使用PREVENT和PCE计算预测事件数，并根据实际随访时长进行调整，然后与试验期间及延长随访期间观察到的事件数进行比较。
结果
在15510名年龄在65至79岁（中位年龄73.2岁；56.1%为女性）的参与者中，发生了1084例ASCVD事件（中位随访时间8.3年）；PCE预测3102例事件，而PREVENT预测1290例事件。对于2787名年龄≥80岁（中位年龄82.6岁；59.2%为女性）的参与者，发生了355例ASCVD事件（中位随访时间7.4年）；PCE预测1067例事件，而PREVENT预测350例事件。与PCE相比，PREVENT表现出更好的判别性能（PREVENT与PCE，C统计量，0.793对0.740；65至79岁参与者中P<0.001；0.854对0.799；80岁及以上参与者中P<0.001）。
结论
在预测来自美国和澳大利亚的老年人（包括80岁及以上人群）的ASCVD事件方面，PREVENT风险计算器优于PCE计算器。
注册信息
网址：https://www.clinicaltrials.gov；唯一标识符：NCT01038583。网址：https://www.isrctn.com；唯一标识符：ISRCTN83772183。
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