Thompson S G, Pyke S D, Wood D A
Medical Statistics Unit, London School of Hygiene and Tropical Medicine, UK.
J Cardiovasc Risk. 1996 Jun;3(3):301-6.
To investigate whether a risk score proposed by the British Regional Heart Study (BRHS), derived from data collected in 1978-1980, provides an appropriate basis for current coronary risk factor screening and intervention in general practice.
The BRHS risk score was applied to 1993 men aged 40-59 years and 1353 women aged 35-59 years, from 13 general practices in England, Wales and Scotland, who had health checks during 1991-1992 in the British Family Heart Study (FHS). Modifications to the BRHS risk score were made in order to identify subjects with a current high risk compared with others of the same age and sex. These were validated on 3272 men and 2229 women recruited from different general practices during 1992-1994 in the FHS.
Only 9% of men in the FHS fell into the published top (highest risk) quintile of the BRHS score, versus an expected 20%, and 44% fell into the bottom quintile. Scores were, on average, substantially lower in the FHS men than in the BRHS men, principally because of lower measured cholesterol levels (using a Reflotron) and a lower prevalence of cigarette-smoking. The BRHS scores also tended to increase with age, disproportionately identifying older subjects, and were substantially lower in women than in men. Simple age-related modifications to the risk score were therefore devised to overcome these problems. These modifications performed well in the validation.
The substantial difference in risk scores between the BRHS and FHS men may reflect both a real reduction in risk and changes in calibration and methodology. Current use of the BRHS risk score may therefore mislead doctors and patients in the direction of complacency. In addition, the published BRHS risk score has an age-dependence that is undesirable in terms of guiding the intensity of lifestyle intervention which should be offered to an individual patient. The simple modifications proposed provide a more appropriate basis for coronary risk factor screening and intervention in general practice, and one that can be used both for men and for women.
调查由英国地区心脏研究（BRHS）于1978 - 1980年收集的数据得出的风险评分，是否能为当前全科医疗中的冠状动脉风险因素筛查及干预提供合适依据。
将BRHS风险评分应用于来自英格兰、威尔士和苏格兰13家全科诊所的1993名40 - 59岁男性和1353名35 - 59岁女性，这些人在1991 - 1992年英国家庭心脏研究（FHS）期间接受了健康检查。对BRHS风险评分进行修改，以识别与同年龄、同性别的其他人相比当前处于高风险的受试者。这些修改在1992 - 1994年FHS期间从不同全科诊所招募的3272名男性和2229名女性中得到验证。
FHS中只有9%的男性处于已公布的BRHS评分最高（风险最高）五分位数，而预期为20%，44%处于最低五分位数。FHS男性的评分平均显著低于BRHS男性，主要是因为测量的胆固醇水平较低（使用反射光度计）以及吸烟率较低。BRHS评分也往往随年龄增加，不成比例地识别出年龄较大的受试者，且女性的评分显著低于男性。因此设计了与年龄相关的简单风险评分修改方法来克服这些问题。这些修改在验证中表现良好。
BRHS和FHS男性之间风险评分的显著差异可能既反映了实际风险的降低，也反映了校准和方法的变化。因此，当前使用BRHS风险评分可能会在自满方向上误导医生和患者。此外，已公布的BRHS风险评分具有年龄依赖性，这在指导应向个体患者提供的生活方式干预强度方面是不可取的。所提出的简单修改为全科医疗中的冠状动脉风险因素筛查及干预提供了更合适的依据，并且可同时用于男性和女性。
