摘要
背景:虽然对动脉粥样硬化的认识有所深入,但预测女性心血管事件的方法在很大程度上仍依赖于传统的危险因素。目的:基于大量的传统和新型危险因素确立预测女性心血管事件风险的方法并进行验证。设计、机构和参与者:对24558例最初健康且年龄≥45岁的美国女性进行中位时间10.2年(至2004年3月)的随访,评估35个因素对新发心血管事件(经判定的心肌梗死、缺血性卒中、冠状动脉血运重建和心血管死亡联合终点)的预测作用。
Context: Despite improved understanding of atherothrombosis, cardiovascular prediction algorithms for women have largely relied on traditional risk factors. Objective: To develop and validate cardiovascular risk algorithms for women based on a large panel of traditional and novel risk factors. Design, Setting, and Participants: Thirty-five factors were assessed among 24 558 initially healthy US women 45 years or older who were followed up for a median of 10.2 years(through March 2004) for incident cardiovascular events(an adjudicated composite of myocardial infarction, ischemic stroke, coronary revascularization, and cardiovascular death). We used data among a random two thirds(derivation cohort, n=16 400) to develop new risk algorithms that were then tested to compare observed and predicted outcomes in the remaining one third of women(validation cohort, n=8158). Main Outcome Measure: Minimization of the Bayes Information Criterion was used in the derivation cohort to develop the best-fitting parsimonious prediction models. In the validation cohort, we compared predicted vs actual 10-year cardiovascular event rates when the new algorithms were compared with models based on covariates included in the Adult Treatment Panel III risk score. Results: In the derivation cohort, a best-fitting model(model A) and a clinically simplified model(model B, the Reynolds Risk Score) had lower Bayes Information Criterion scores than models based on covariates used in Adult Treatment Panel III. In the validation cohort, all measures of fit, discrimination, and calibration were improved when either model A or B was used. For example, among participants without diabetes with estimated 10-year risks according to the Adult Treatment Panel III of 5% to less than 10% (n=603) or 10% to less than 20% (n=156), model A reclassified 379(50% ) into higher- or lower-risk categories that in each instance more accurately matched actual event rates. Similar effects were achieved for clinically simplified model B limited to age, systolic blood pressure, hemoglobin A1c if diabetic, smoking, total and high-density lipoprotein cholesterol, high-sensitivity C-reactive protein, and parental history of myocardial infarction before age 60 years. Neither new algorithm provided substantive information about women at very low risk based on the published Adult Treatment Panel III score. Conclusion: We developed, validated, and demonstrated highly improved accuracy of 2 clinical algorithms for global cardiovascular risk prediction that reclassified 40% to 50% of women at intermediate risk into higher- or lower-risk categories.
