利用金属生物标志物提高心血管疾病死亡率的预测性能。

IF 5.3 2区 环境科学与生态学 Q1 ENVIRONMENTAL SCIENCES
Samuel D Fansler, Kelly M Bakulski, Sung Kyun Park, Erika Walker, Xin Wang
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引用次数: 0

摘要

背景:加入额外的环境风险因素是否能提高心血管疾病(CVD)预测效果尚不清楚。除了传统的心血管疾病风险因素外,我们还尝试使用尿液和血液中检测到的金属以及统计机器学习方法来提高心血管疾病死亡率的预测性能:我们的样本包括 2003-2004 年至 2015-2016 年国家健康与营养调查中年龄在 40 岁或以上的 7085 名美国成年人,这些数据与国家死亡指数的链接截止日期为 2019 年 12 月 31 日。数据随机分成50/50的训练数据集和测试数据集,训练数据集用于构建心血管疾病死亡率预测模型(n = 3542),测试数据集用作验证,以评估预测性能(n = 3543)。相对于传统的风险因素(年龄、性别、种族/民族、吸烟状况、收缩压、总胆固醇和高密度脂蛋白胆固醇、高血压和糖尿病),我们比较了另外 17 种血液和尿液金属浓度的模型。为了建立预测模型,我们使用了 Cox 比例危险度法、弹性网(ENET)惩罚性 Cox 法和随机生存森林法:420名参与者死于心血管疾病,平均随访时间为8.8年。血铅、镉和汞与心血管疾病相关(p 结论:血铅、镉和汞与心血管疾病相关:纳入血液金属可略微提高心血管疾病死亡风险辨别能力,而血液和尿液金属则可提高风险再分类能力,突出了它们在改善心血管风险评估方面的潜在作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Use of biomarkers of metals to improve prediction performance of cardiovascular disease mortality.

Background: Whether including additional environmental risk factors improves cardiovascular disease (CVD) prediction is unclear. We attempted to improve CVD mortality prediction performance beyond traditional CVD risk factors by additionally using metals measured in the urine and blood and with statistical machine learning methods.

Methods: Our sample included 7,085 U.S. adults aged 40 years or older from the National Health and Nutrition Examination Survey 2003-2004 through 2015-2016, linked with the National Death Index through December 31, 2019. Data were randomly split into a 50/50 training dataset used to construct CVD mortality prediction models (n = 3542) and testing dataset used as validation to assess prediction performance (n = 3543). Relative to the traditional risk factors (age, sex, race/ethnicity, smoking status, systolic blood pressure, total and high-density lipoprotein cholesterol, hypertension, and diabetes), we compared models with an additional 17 blood and urinary metal concentrations. To build the prediction models, we used Cox proportional hazards, elastic-net (ENET) penalized Cox, and random survival forest methods.

Results: 420 participants died from CVD with 8.8 mean years of follow-up. Blood lead, cadmium, and mercury were associated (p < 0.005) with CVD mortality. Including these blood metals in a Cox model, initially containing only traditional risk factors, raised the C-index from 0.845 to 0.847. Additionally, the Net Reclassification Index showed that 23% of participants received a more accurate risk prediction. Further inclusion of urinary metals improved risk reclassification but not risk discrimination.

Conclusions: Incorporating blood metals slightly improved CVD mortality risk discrimination, while blood and urinary metals enhanced risk reclassification, highlighting their potential utility in improving cardiovascular risk assessments.

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来源期刊
Environmental Health
Environmental Health 环境科学-公共卫生、环境卫生与职业卫生
CiteScore
10.10
自引率
1.70%
发文量
115
审稿时长
3.0 months
期刊介绍: Environmental Health publishes manuscripts on all aspects of environmental and occupational medicine and related studies in toxicology and epidemiology. Environmental Health is aimed at scientists and practitioners in all areas of environmental science where human health and well-being are involved, either directly or indirectly. Environmental Health is a public health journal serving the public health community and scientists working on matters of public health interest and importance pertaining to the environment.
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