† Omega-3 index improves upon the pooled cohort equation in predicting risk for CVD

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY

Journal of clinical lipidology Pub Date : 2025-05-01 DOI:10.1016/j.jacl.2025.04.030

William Franco MD, James O'Keefe MD, Nathan Tintle PhD, Evan O'Keefe MD, Roberto Marchioli MD, William Harris PhD

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引用次数: 0

Abstract

Background/Synopsis

Accurate predictive tools are crucial for identifying patients at increased risk for atherosclerotic cardiovascular disease (ASCVD). The Pooled Cohort Equation (PCE) is commonly used to predict 10-year risk for ASCVD, but the extent to which it can be improved upon by the inclusion of a measure of omega-3 fatty acid status is unknown.

Objective/Purpose

This study examined the extent to which the omega-3 Index (O3I; the proportion of EPA+DHA in erythrocyte membranes) improved the predictive capability of the PCE and each of its modifiable components.

Methods

The O3I was determined in 2,550 participants without ASCVD at baseline from Framingham Offspring Cohort. The extent to which the O3I added to the PCE score was assessed using the area under the curve (AUC) metric. Changes in the AUC were also used to determine the extent to which the O3I added predictive power to each standard risk factor (blood pressure, diabetes, smoking, total and HDL cholesterol) individually when added to the basic (age+sex+race) model. Median follow-up was 10 years.

Results

The AUC predicting 10-year ASCVD events using PCE was 0.689. It increased to 0.698 upon addition of the O3I (p < 0.05). When added to the basic model, the O3I increased the AUC by 0.012 units; this compared with 0.028 for blood pressure and for HDL-C; 0.020 for diabetes, 0.006 for cholesterol, and 0.004 for smoking [all but smoking were significant (p < 0.05)]. Thus, the predictive power provided by the O3I was roughly equivalent to that provided by each of the 5 standard risk factors. Also, the O3I significantly (p < 0.05) improved the predictive ability of each of these risk factors when analyzed separately (Figure). This suggests that the mechanism(s) by which a higher O3I operates to lower risk is, at least in part, independent of effects on these other risk factors. Interestingly, the 6 additional factors together (beyond age, sex and race) increased the AUC by only 0.068 units (i.e., from 0.672 to 0.740), indicating that most of the predictive power of the PCE is derived from fixed, unmodifiable risk factors.

Conclusions

The O3I improved the PCE prediction, suggesting that it captures risk beyond standard factors. Thus, the O3I may help in ASCVD risk stratification. Further research is needed to extend these findings into more diverse cohorts and to explore the integration of O3I into other existing ASCVD risk assessment tools.

Previously Published: Yes, Currently accepted (Dec 13, 20024) at Journal of Clinical Lipidology.

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†ω -3指数在预测心血管疾病风险时改善了合并队列方程

背景/摘要准确的预测工具对于识别动脉粥样硬化性心血管疾病（ASCVD）风险增加的患者至关重要。合并队列方程（PCE）通常用于预测ASCVD的10年风险，但在多大程度上可以通过纳入omega-3脂肪酸状态的测量来改善尚不清楚。目的/目的本研究考察了omega-3指数(O3I；（红细胞膜中EPA+DHA的比例）提高了PCE及其各可修饰成分的预测能力。方法对来自Framingham后代队列的2550名无ASCVD的受试者进行O3I测定。使用曲线下面积（AUC）指标评估O3I对PCE评分的影响程度。AUC的变化也被用来确定O3I在加入基本（年龄+性别+种族）模型时，对每个标准危险因素（血压、糖尿病、吸烟、总胆固醇和高密度脂蛋白胆固醇）单独增加预测能力的程度。中位随访时间为10年。结果PCE预测10年ASCVD事件的AUC为0.689。加入O3I (p <；0.05)。添加到基础车型时，O3I使AUC增加0.012个单位；相比之下，血压和HDL-C的平均值为0.028；糖尿病患病率为0.020，胆固醇患病率为0.006，吸烟患病率为0.004[除吸烟外，其他均显著(p <；0.05)]。因此，O3I提供的预测能力大致相当于5个标准风险因素中的每一个提供的预测能力。此外，O3I显著(p <；0.05)单独分析时，提高了这些危险因素的预测能力（图）。这表明，较高的O3I降低风险的机制至少在一定程度上独立于这些其他风险因素的影响。有趣的是，6个额外的因素加在一起（除了年龄、性别和种族），AUC只增加了0.068个单位（即从0.672增加到0.740），这表明PCE的大部分预测能力来自固定的、不可改变的危险因素。结论O3I改善了PCE的预测，表明它捕获了超出标准因素的风险。因此，O3I可能有助于ASCVD风险分层。需要进一步的研究将这些发现扩展到更多样化的队列中，并探索将O3I整合到其他现有的ASCVD风险评估工具中。先前发表：是的，目前被接受（20024年12月13日）在Journal of Clinical Lipidology。

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来源期刊

Journal of clinical lipidology 医学-药学

CiteScore

7.00

自引率

6.80%

发文量

209

审稿时长

49 days

期刊介绍： Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. Sections of Journal of clinical lipidology will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.