China-PAR与WHO模型预测10年心血管病风险的准确性  

Accuracy of the China-PAR and WHO risk models in predicting the ten-year risks of cardiovascular disease in the Chinese population

作　　者：陈暐烨 刘晓非 沈鹏[2] 陈奇[2] 孙烨祥 邬金国 路平 张敬谊[3] 林鸿波[2] 唐迅[4] 高培[1,5] Chen Weiye;Liu Xiaofei;Shen Peng;Chen Qi;Sun Yexiang;Wu Jinguo;Lu Ping;Zhang Jingyi;Lin Hongbo;Tang Xun;Gao Pei(Department of Epidemiology and Biostatistics,Peking University School of Public Health,Beijing 100191,China;Yinzhou District Center for Disease Control and Prevention,Ningbo 315100,China;Wonders Information Co.Ltd,Shanghai 201112,China;Center of Real-world Evidence Evaluation,Peking University Clinical Research Institute,Beijing 100191,China;Key Laboratory of Molecular Cardiovascular Sciences(Peking University),Ministry of Education,Beijing 100191,China)

机构地区：[1]北京大学公共卫生学院流行病与卫生统计学系,北京100191 [2]宁波市鄞州区疾病预防控制中心,宁波315100 [3]万达信息股份有限公司,上海201112 [4]北京大学临床研究所真实世界证据评价中心,北京100191 [5]北京大学分子心血管学教育部重点实验室,北京100191

出　　处：《中华流行病学杂志》2022年第8期1275-1281,共7页Chinese Journal of Epidemiology

基　　金：国家重点研发计划(2020YFC2003503);国家自然科学基金(81973132,81961128006)。

摘　　要：目的在我国社区人群中独立验证并比较中国动脉粥样硬化性心血管疾病风险预测研究(China-PAR)模型与2019年WHO开发的东亚人群心血管病风险评估工具预测10年心血管病风险的准确性。方法2010年1月1日至2020年5月31日中国鄞州电子健康档案研究中基线无心血管病史的40~79岁人群。采用Kaplan-Meier法计算10年心血管病实际发生风险,并采用China-PAR模型、WHO复杂模型和简易模型分别计算预测风险。通过区分度C统计量、校准度χ^(2)值和校准图评价模型的准确性。结果共纳入225811名研究对象,经过中位随访7.26年,共发生13301例心血管病事件。China-PAR模型、WHO复杂模型和WHO简易模型的C统计量及其95%CI在男性中分别为0.741(0.735~0.747)、0.747(0.740~0.753)和0.739(0.733~0.746),在女性中分别为0.782(0.776~0.788)、0.789(0.783~0.795)和0.782(0.776~0.787)。WHO复杂模型和简易模型预测男性10年心血管病风险整体分别低估了0.8%和4.4%,在女性中整体均低估了约15%;而China-PAR模型整体低估风险,在男性和女性中分别低估了19.5%和42.3%。结论在我国社区人群总体风险评估中China-PAR和WHO模型预测10年心血管病风险均具有较好的区分度,但对于高风险组人群的预测准确性还有待改善,提示仍需进一步针对高风险组(如糖尿病或老年)人群建立单独的风险预测模型。Objective To externally validate and compare the accuracy of the China-PAR(Prediction for ASCVD Risk in China)model and the 2019 World Health Organization(WHO)cardiovascular disease risk charts for East Asian in predicting a 10-year cardiovascular disease in a general Chinese population.Methods Participants aged 40-79 years without prior cardiovascular disease at baseline in the CHinese Electronic health Records Research in Yinzhou(CHERRY)were analyzed.The Kaplan-Meier analysis estimated the observed cardiovascular events(including non-fatal myocardial infarction,fatal coronary heart disease,and non-fatal or fatal stroke)rate within ten years.The expected risks were calculated using the WHO risk charts for East Asia(including the laboratory-based and non-laboratory-based models)and the China-PAR model.The expected-observed ratios were calculated to evaluate the overestimation or underestimation of the models in the cohort.Model accuracy was assessed by discrimination C-index,calibrationχ^(2)value,and calibration plots.Results During a median of 7.26 years of follow-up,13301 cardiovascular events were identified among 225811 participants.The C-index for the China-PAR model,WHO laboratory-based model and WHO non-laboratory-based model were 0.741(0.735-0.747),0.747(0.740-0.753),and 0.739(0.733-0.746)for men,and 0.782(0.776-0.788),0.789(0.783-0.795),and 0.782(0.776-0.787)for women,respectively.The WHO laboratory-based model and non-laboratory-based model underestimated the 10-year ASCVD risk by around 15%in women and underestimated by 0.8%and 4.4%in men,respectively.The China-PAR model underestimated the risks by 19.5%and 42.3%for men and women.Conclusions The China-PAR and WHO models all have pretty good discriminations for 10-year cardiovascular risk assessment in this general Chinese population.However,the accuracy should be improved in the highest-risk groups,suggesting further specific models are still needed for those with the highest risk,such as patients with diabetes or older persons.

关 键 词：心血管病 风险评估 预测模型 队列研究 

分 类 号：R54[医药卫生—心血管疾病]