美国心脏协会的PREVENT方程的开发和验证
Sadiya S Khan1, Kunihiro Matsushita2, Yingying Sang2,3
1Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.S.K.).
Circulation
|November 10, 2023
概括
美国心脏协会新的PREVENT方程使用常见的临床因素准确预测美国成年人的心血管疾病 (CVD) 风险. 这些经过验证的方程改善了对心血管疾病事件的初级预防的风险评估.
科学领域:
- 心血管疾病流行病学
- 风险预测模型
- 预防性心脏病学
背景情况:
- 目前用于心血管疾病 (CVD) 风险评估的多变量方程存在局限性.
- 主要预防指南建议使用心血管疾病风险评估方程.
- 需要新的方程来解决现有的心血管疾病风险预测的局限性.
研究的目的:
- 开发和验证美国心脏协会预测心血管疾病风险 (PREVENT) 方程.
- 评估30至79岁美国未患有心血管疾病的成年人心血管疾病风险.
- 使用传统的风险因子和估计的膜过率,创建性别特异性方程.
主要方法:
- 在1992年至2017年期间,利用了25个数据集 (N=3,281,919) 的个人级别数据进行导出.
- 包括传统的心血管疾病风险因素 (吸烟,血压,胆固醇,药物使用,糖尿病) 和eGFR.
- 对性别特异性,无种族特异性的模型进行了元分析,调整为竞争风险;对333085名参与者进行了外部验证.
主要成果:
- 包括 6, 612, 004 名成年人; 随访时间中位数为 4. 8 年; 心血管疾病事件为 211, 515.
- 外部验证显示出良好的分辨率 (C统计中位数:女性0. 794,男性0. 757) 和校准 (斜率:女性1. 03,男性0. 94).
- 添加可选预测因子 (尿中的白蛋白与肌素的比率,HbA1c,社会剥夺指数) 显示了歧视的小但显著的改善.
结论:
- PREVENT方程准确地预测了美国大量多样化的成人心血管疾病和心血管疾病亚型.
- 这些方程有效地利用常规可用的临床变量来预测风险.
- 这些已验证的方程为心血管疾病的初级预防提供了更好的工具.
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