动脉样硬化心血管疾病的验证 聚合 队列风险方程
Paul Muntner1, Lisandro D Colantonio2, Mary Cushman3
1Department of Epidemiology, University of Alabama at Birmingham2Department of Medicine, University of Alabama at Birmingham.
JAMA
|April 1, 2014
概括
ACC/AHA聚合队列风险方程准确估计了美国成年人被考虑接受他类药物治疗的5年动脉样硬化心血管疾病 (CVD) 风险. 这些方程显示了良好的校准和区别,支持在临床决策中使用它们.
科学领域:
- 心血管医学 心血管医学
- 流行病学 流行病学
- 预防性心脏病学 预防性心脏病学
背景情况:
- 美国心脏病学会/美国心脏协会 (ACC/AHA) 聚合队列风险方程对于估计动脉样硬化心血管疾病 (CVD) 风险至关重要.
- 这些方程指导了关于初级预防中使用他类药物的决定.
- 在当代美国人口中验证对于确保它们的持续有用性至关重要.
研究的目的:
- 评估ACC/AHA聚合队列风险方程的校准和歧视.
- 在当代美国人口中评估这些风险方程的准确性.
- 为了确定指导他类药物启动的方程的可靠性.
主要方法:
- 分析了10997名年龄在45-79岁的成年人,这些成年人来自"因地缘和种族差异导致中风的原因" (REGARDS) 研究 (2003-2010).
- 专注于没有现有心血管疾病或糖尿病的参与者,LDL-C 70-189 mg/dL,而不是他类药物.
- 预测5年动脉样硬化心脏病风险与观察到的判断事件 (非致命性心脏病,心脏病死亡,中风) 的比较,包括部分医疗保险索赔数据.
主要成果:
- 观察和预测的5年动脉样硬化心血管疾病发病率在风险层之间显示出强烈的一致性 (<5%,5-7.5%,7.5-10%,≥10%).
- 歧视的C指数在主要队列中为0.72,在医疗保险相关子组中为0.67.
- 霍斯默-莱梅肖测试表明,在与医疗保险相关的组中,校准良好 (P=.71).
结论:
- 在ACC/AHA聚合队列风险方程中,在当代美国人口中显示出良好的校准和中等到良好的歧视.
- 这些发现支持继续使用这些方程来评估动脉样硬化心血管疾病风险,并告知他类药物治疗决策.
- 该研究验证了风险方程在目标人群中的可靠性,这些人群是它们的目标.
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