Laboratory-based versus non-laboratory-based method for assessment of cardiovascular disease risk: the NHANES I Follow-up Study cohort

被引:253
作者
Gaziano, Thomas A. [1 ,5 ]
Young, Cynthia R. [3 ]
Fitzmaurice, Garrett [4 ]
Atwood, Sidney [2 ]
Gaziano, J. Michael
机构
[1] Brigham & Womens Hosp, Div Cardiovasc Med, Boston, MA 02115 USA
[2] Brigham & Womens Hosp, Div Social Med & Hlth Inequal, Boston, MA 02115 USA
[3] Harvard Univ, Sch Med, Boston, MA USA
[4] McLean Hosp, Lab Psychiat Biostat, Belmont, MA 02178 USA
[5] Brigham & Womens Hosp, VA Boston Healthcare Syst, Boston, MA 02115 USA
基金
美国国家卫生研究院;
关键词
D O I
10.1016/S0140-6736(08)60418-3
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Around 80% of all cardiovascular deaths occur in developing countries. Assessment of those patients at high risk is an important strategy for prevention. Since developing countries have limited resources for prevention strategies that require laboratory testing, we assessed if a risk prediction method that did not require any laboratory tests could be as accurate as one requiring laboratory information. Methods The National Health and Nutrition Examination Survey (NHANES) was a prospective cohort study of 14407 US participants aged between 25-74 years at the time they were first examined (between 1971 and 1975). Our follow-up study population included participants with complete information on these surveys who did not report a history of cardiovascular disease (myocardial infarction, heart failure, stroke, angina) or cancer, yielding an analysis dataset N=6186. We compared how well either method could predict first-time fatal and non-fatal cardiovascular disease events in this cohort. For the laboratory-based model, which required blood testing, we used standard risk factors to assess risk of cardiovascular disease: age, systolic blood pressure, smoking status, total cholesterol, reported diabetes status, and current treatment for hypertension. For the non-laboratory-based model, we substituted body-mass index for cholesterol. Findings in the cohort of 6186, there were 1529 first-time cardiovascular events and 578 (38%) deaths due to cardiovascular disease over 21 years. In women, the laboratory-based model was 0.831. In men, the results were similar (0.784 for the laboratory-based model and 0.783 for the non-laboratory-based model). Results were similar between the laboratory-based and non-laboratory-based models in both men and women when restricted to fatal events only. Interpretation A method that uses non-laboratory-based risk factors predicted cardiovascular events as accurately as one that relied on laboratory-based values. This approach could simplify risk assessment in situations where laboratory testing is inconvenient or unavailable.
引用
收藏
页码:923 / 931
页数:9
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