在伊朗人口中,SCORE2心血管风险预测算法的验证和临床有用性
Ehsan Shahrestanaki1, Masoud Solaymani-Dodaran1, Morteza Mohammadzadeh2
1Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
SCORE2心血管疾病 (CVD) 风险模型显示,伊朗人,特别是女性受到良好的歧视,但低估了风险. 建议进行重新校准,以提高预防策略的临床效用.
科学领域:
- 心血管疾病流行病学
- 健康研究成果研究结果
- 风险预测建模风险预测建模
背景情况:
- SCORE2模型估计了欧洲人口的10年心血管疾病 (CVD) 风险.
- 外部验证对于评估模型在不同族群中的适用性至关重要.
- 德黑兰脂质和葡萄糖研究 (TLGS) 队列为验证伊朗人口中的风险模型提供了数据.
研究的目的:
- 在伊朗成年人群中对SCORE2风险预测模型进行外部验证.
- 评估SCORE2模型对伊朗心血管疾病风险分层的临床有用性.
- 为了比较SCORE2模型的性能与TLGS队列的本地CVD发病率数据.
主要方法:
- 利用了TLGS队列中的4,579名成年人 (40-69岁) 的数据,这些成年人以前没有心血管疾病.
- 采用Fine和Gray竞争风险模型来估计特定性别的回归系数.
- 使用歧视 (C指数) 和校准 (O/E比率) 评估模型性能,以及敏感性,特异性和决策曲线分析等临床实用性指标.
主要成果:
- SCORE2模型表现出良好的歧视,女性的C指数值 (0.80) 比男性 (0.70) 高.
- 该模型倾向于低估男性和女性的心血管疾病风险 (男性的O/E比率为2.05,女性为1.50).
- 决策曲线分析表明临床有用性,特别是对于中间风险分层 (7.5-15%).
结论:
- 经过验证的SCORE2模型在伊朗人口中表现出强大的歧视力,特别是在女性中.
- 校准问题表明需要重新校准,以准确反映当地的心血管疾病风险.
- 该模型的净收益支持其在指导预防干预方面的有用性,根据国家数据进行更新是有必要的.
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