心血管风险评估的多模式策略:在2个基于人口的队列中的表现
James A de Lemos1, Colby R Ayers2, Benjamin D Levine2
1From Departments of Medicine (J.A.d.L., B.L., J.P.B., D.K.M., M.H.D., A.K.) and Clinical Sciences (C.R.A., J.D.B., D.K.M.), University of Texas Southwestern Medical Center, Dallas; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian, Dallas (B.L.); Inova Heart and Vascular Institute, Fall Church, VA (C.R.d.); Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (T.J.W.); Departments of Medicine and Radiological Sciences, Wake Forest Health Sciences, Winston-Salem, NC (W.G.H.); Department of Medicine, University of Maryland School of Medicine, Baltimore (S.L.S.); The Johns Hopkins University School of Medicine, Baltimore, MD (P.O.); Los Angeles Biomedical Research Institute, CA (M.B.); Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (P.G.); and Baylor College of Medicine, Houston, TX (G.M.B.). james.delemos@utsouthwestern.edu.
一项新的多模式测试策略显著改善了未患有心血管疾病的成年人心血管疾病风险评估. 结合生物标志物可以提高全球性心血管疾病和动脉样性心血管疾病 (ASCVD) 的预测.
科学领域:
- 心脏病学
- 预防医学
- 生物标志物发现
背景情况:
- 目前的心血管疾病 (CVD) 风险评估工具在性能和范围上有局限性,特别是在动脉样硬化性心血管疾病 (ASCVD) 中.
- 需要改善无症状成年人的风险分层策略,以预防心血管疾病事件.
研究的目的:
- 评估一种新的多模式测试策略,以改善整体和动脉样硬化心血管疾病风险评估.
- 确定多种生物标志物的结合是否能提高未确立心血管疾病的个体的风险预测.
主要方法:
- 使用了多民族动脉样硬化研究 (MESA) 和达拉斯心脏研究 (DHS) 队列的数据.
- 评估左心室缩 (ECG),冠状动脉,N-终端亲B型尿素,高灵敏度心脏素T,以及高灵敏度C反应蛋白.
- 分析了与10年全球综合心血管疾病结果和ASCVD事件的关联,并对传统风险因素进行了调整.
主要成果:
- 每个生物标志物独立预测全球心血管疾病事件.
- 整合五项测试改善了风险预测模型的性能 (c-统计从0.74到0.79,P=0.001),并显著改善了重新分类.
- 基于异常测试的简单整数得分显示了与全球心血管疾病风险增加的分级关联,在DHS和ASCVD结果中复制.
结论:
- 结合心电图衍生的左心室缩,冠状动脉,NT-proBNP,hs-cTnT和hs-CRP的多模式检测策略显著提高了心血管疾病和ASCVD风险评估.
- 这种方法为没有已知的心血管疾病的成年人提供了更全面的风险分层.
- 这些发现支持结合多种生物标志物的临床实用性,以改善心血管风险预测.
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