增加风险增强因素可改善中国中老年成人动脉粥样硬化性心血管疾病的风险评估:来自中国多省队列研究的结果

IF 0.9 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular Innovations and Applications Pub Date : 2023-01-01 DOI:10.15212/cvia.2023.0036
Haimei Wang, Zhaorui Yang, Y. Qi, Yulin Huang, Luoxi Xiao, Yiming Hao, Jia-yi Sun, Miaoyang Wang, Q. Deng, Y. Hao, N. Yang, Jing Liu
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引用次数: 0

摘要

目的:本研究旨在探讨将风险增强因素纳入中国心脏病学会推荐的ASCVD临床风险评估工具(即CSC模型)是否可以改善中国成人10年ASCVD风险分层。方法:纳入2007-2008年中国多省队列研究中50-79岁无心血管疾病的4910名中国参与者。我们通过在CSC模型中单独添加风险增强因素或增加风险增强因素的数量来评估更新模型的临床效用(即Harrell c指数和净重分类改善[NRI]),适用于所有个体或处于中等风险的个体。评估风险增强因素,包括CVD家族史、甘油三酯≥2.3 mmol/L、高敏c反应蛋白≥2 mg/L、脂蛋白(a)≥50 mg/dL、非高密度脂蛋白胆固醇≥4.9 mmol/L、超重/肥胖和中心性肥胖。ASCVD事件被定义为包括缺血性卒中和急性冠心病事件(包括非致死性急性心肌梗死和所有冠状动脉死亡)的复合终点。结果:在中位10年随访期间,记录了449例(9.1%)ASCVD事件。在CSC模型中加入≥2个风险增强因素后,总体人群的c -指数显著改善(1.0%,95%可信区间[CI]: 0.2-1.7%), NRI略有改善(2.0%,95% CI: - 1.2-5.4%)。对于中危人群,特别是ASCVD高危人群,在CSC模型中加入≥2个风险增强因素后,NRI显著改善(17.4%,95% CI: 5.6-28.5%)。结论:增加≥2个风险增强因素可细化10年ASCVD风险分层,特别是对中等风险个体,支持其在临床实践中帮助定制有针对性干预措施的潜力。
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Addition of Risk-enhancing Factors Improves Risk Assessment of Atherosclerotic Cardiovascular Disease in Middle-aged and Older Chinese Adults: Findings from the Chinese Multi-provincial Cohort Study
Objective: This study aimed to examine whether integrating risk-enhancing factors into the Chinese Society of Cardiology-recommended clinical risk assessment tool (i.e., the CSC model) for atherosclerotic cardiovascular disease (ASCVD) might improve 10-year ASCVD risk stratification in Chinese adults. Methods: A total of 4910 Chinese participants who were 50–79 years of age and free of cardiovascular disease in the 2007–2008 Survey from the Chinese Multi-provincial Cohort Study were included. We assessed the updated model’s clinical utility (i.e., Harrell’s C-index and net reclassification improvement [NRI]) by adding risk-enhancing factors individually or the number of risk-enhancing factors to the CSC model, for all individuals or those at intermediate risk. Risk-enhancing factors, including a family history of CVD, triglycerides ≥2.3 mmol/L, high-sensitivity C-reactive protein ≥2 mg/L, Lipoprotein (a) ≥50 mg/dL, non-high-density lipoprotein cholesterol ≥4.9 mmol/L, overweight/obesity, and central obesity, were evaluated. ASCVD events were defined as a composite endpoint comprising ischemic stroke and acute coronary heart disease events (including nonfatal acute myocardial infarction and all coronary deaths). Results: During a median 10-year follow-up, 449 (9.1%) ASCVD events were recorded. Addition of ≥2 risk-enhancing factors to the CSC model yielded a significant improvement in the C-index (1.0%, 95% confidence interval [CI]: 0.2–1.7%) and a modest improvement in the NRI (2.0%, 95% CI: −1.2–5.4%) in the total population. For intermediate-risk individuals, particularly individuals at high risk of developing ASCVD, significant improvements in NRI were observed after adding ≥2 risk-enhancing factors (17.4%, 95% CI: 5.6–28.5%) to the CSC model. Conclusions: Addition of ≥2 risk-enhancing factors refined 10-year ASCVD risk stratification, particularly for intermediate-risk individuals, supporting their potential in helping tailor targeted interventions in clinical practice.
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Cardiovascular Innovations and Applications
Cardiovascular Innovations and Applications CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
0.80
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20.00%
发文量
222
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