Predicting the 30-Year Risk of Cardiovascular Disease The Framingham Heart Study

被引:635
作者
Pencina, Michael J. [1 ,2 ,4 ]
D'Agostino, Ralph B., Sr. [1 ,2 ,4 ]
Larson, Martin G. [2 ,4 ]
Massaro, Joseph M. [1 ,2 ,4 ]
Vasan, Ramachandran S. [3 ,4 ]
机构
[1] Boston Univ, Dept Biostat, Boston, MA 02215 USA
[2] Boston Univ, Dept Math & Stat, Boston, MA 02215 USA
[3] Boston Univ, Sch Med, Boston, MA 02215 USA
[4] Framingham Heart Dis Epidemiol Study, Framingham, MA USA
基金
美国国家卫生研究院;
关键词
atherosclerosis; competing risk; lifetime risk; obesity; risk factors; C-REACTIVE PROTEIN; LIFETIME RISK; FOLLOW-UP; COMPETING RISKS; FACTOR BURDEN; SCORE; POPULATION; VALIDATION; PROFILE; STROKE;
D O I
10.1161/CIRCULATIONAHA.108.816694
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-Present cardiovascular disease (CVD) risk prediction algorithms were developed for a <= 10-year follow up period. Clustering of risk factors at younger ages and increasing life expectancy suggest the need for longer-term risk prediction tools. Methods and Results-We prospectively followed 4506 participants (2333 women) of the Framingham Offspring cohort aged 20 to 59 years and free of CVD and cancer at baseline examination in 1971-1974 for the development of "hard" CVD events (coronary death, myocardial infarction, stroke). We used a modified Cox model that allows adjustment for competing risk of noncardiovascular death to construct a prediction algorithm for 30-year risk of hard CVD. Cross-validated survival C statistic and calibration chi(2) were used to assess model performance. The 30-year hard CVD event rates adjusted for the competing risk of death were 7.6% for women and 18.3% for men. Standard risk factors (male sex, systolic blood pressure, antihypertensive treatment, total and high-density lipoprotein cholesterol, smoking, and diabetes mellitus), measured at baseline, were significantly related to the incidence of hard CVD and remained significant when updated regularly on follow-up. Body mass index was associated positively with 30-year risk of hard CVD only in models that did not update risk factors. Model performance was excellent as indicated by cross-validated discrimination C = 0.803 and calibration chi(2) = 4.25 (P = 0.894). In contrast, 30-year risk predictions based on different applications of 10-year functions proved inadequate. Conclusions-Standard risk factors remain strong predictors of hard CVD over extended follow-up. Thirty-year risk prediction functions offer additional risk burden information that complements that of 10-year functions. (Circulation. 2009; 119: 3078-3084.)
引用
收藏
页码:3078 / U61
页数:9
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