预测法国的冠心病风险:D.E.S.I.R, Three City, PRIME和SU.VI.MAX研究的汇总分析。

J P Empana, M Tafflet, S Escolano, A C Vergnaux, S Bineau, J B Ruidavets, M Montaye, B Haas, S Czernichow, B Balkau, P Ducimetiere
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引用次数: 24

摘要

背景:我们旨在开发和验证一种适用于法国无症状男性和女性的简单冠心病(CHD)风险算法,并将其与上一版Framingham心血管疾病风险函数的准确性进行比较。设计:对四项法国前瞻性一般人群研究进行汇总分析。方法:采用D.E.S.I.R、PRIME、Three City和SU.VI.MAX研究的基线和随访数据。采用Cox比例风险模型估计10年冠心病风险,候选变量包括年龄、性别、体重指数、腰围、冠心病家族史、吸烟状况、糖尿病状况、收缩压、总胆固醇和高密度脂蛋白(HDL)胆固醇。结果:研究人群包括22256名受试者(61.4%男性),年龄(SD) 56.0岁(8.3岁),基线时无个人冠心病史。平均随访8年(2.3年)后,788例首次冠心病发生,其中男性726例,女性62例。最终模型包括年龄、性别、年龄×性别交互作用、当前吸烟状况、糖尿病状况、收缩压、总胆固醇和高密度脂蛋白胆固醇。使用该模型,预测的冠状动脉事件的数量与估计风险的每十分位数内的10年Kaplan-Meier生存估计值相吻合(校准)。该模型具有公平的歧视:Harrell c指数为0.7831 (95% CI: 0.7704-0.7957)。为了比较,重新校准的Framingham风险函数与法国风险方程具有相同的性能。结论:我们基于传统危险因素的10年法国冠心病风险方程的表现至少与重新校准的Framingham心血管疾病风险函数一样好。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Predicting CHD risk in France: a pooled analysis of the D.E.S.I.R., Three City, PRIME, and SU.VI.MAX studies.

Background: We aimed to develop and validate a simple coronary heart disease (CHD) risk algorithm applicable to asymptomatic men and women in France, and to compare its accuracy with that of the last published version of the Framingham risk function for cardiovascular disease.

Design: A pooled analysis of four French prospective general-population studies.

Methods: The baseline and follow-up data from D.E.S.I.R., PRIME, Three City, and SU.VI.MAX studies were used. The 10-year CHD risk was estimated by the Cox proportional hazards model with candidate variables including age, gender, body mass index, waist circumference, family history of coronary heart disease, smoking status, diabetes status, systolic blood pressure, and total and high-density lipoprotein (HDL) cholesterol.

Results: The study population included 22,256 subjects (61.4% men) aged (SD) 56.0 years (8.3) without a personal history of CHD at baseline. After a mean follow-up of 8.0 years (2.3), 788 first CHD events occurred, 726 in men and 62 in women. The final model included age, gender, age × gender interaction, current smoking status, diabetes status, systolic blood pressure, total and HDL cholesterol. Using this model, the number of predicted coronary events fitted that given by the 10-year Kaplan-Meier survival estimates within each decile of estimated risk (calibration). This model had fair discrimination: Harrell C-index, 0.7831 (95% CI: 0.7704-0.7957). For comparison, the recalibrated Framingham risk function had equivalent performances compared to the French risk equation.

Conclusion: Our 10-year French CHD risk equation based on traditional risk factors performed at least as well as the recalibrated Framingham cardiovascular disease risk function.

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