Prediction of Coronary Heart Disease Using Risk Factor Categories

Ovid Technologies (Wolters Kluwer Health) - Tập 97 Số 18 - Trang 1837-1847 - 1998
Peter W.F. Wilson1, Ralph B. D’Agostino1, Daniel Lévy1, Albert M. Belanger1, Halit Silbershatz1, William B. Kannel1
1From the Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, Mass (P.W.F.W., D.L.); Boston University Mathematics Department, Boston, Mass (R.B.D., A.M.B., H.S.); and Framingham Heart Study, Boston University School of Medicine, Framingham, Mass (W.B.K.).

Tóm tắt

Background —The objective of this study was to examine the association of Joint National Committee (JNC-V) blood pressure and National Cholesterol Education Program (NCEP) cholesterol categories with coronary heart disease (CHD) risk, to incorporate them into coronary prediction algorithms, and to compare the discrimination properties of this approach with other noncategorical prediction functions. Methods and Results —This work was designed as a prospective, single-center study in the setting of a community-based cohort. The patients were 2489 men and 2856 women 30 to 74 years old at baseline with 12 years of follow-up. During the 12 years of follow-up, a total of 383 men and 227 women developed CHD, which was significantly associated with categories of blood pressure, total cholesterol, LDL cholesterol, and HDL cholesterol (all P <.001). Sex-specific prediction equations were formulated to predict CHD risk according to age, diabetes, smoking, JNC-V blood pressure categories, and NCEP total cholesterol and LDL cholesterol categories. The accuracy of this categorical approach was found to be comparable to CHD prediction when the continuous variables themselves were used. After adjustment for other factors, ≈28% of CHD events in men and 29% in women were attributable to blood pressure levels that exceeded high normal (≥130/85). The corresponding multivariable-adjusted attributable risk percent associated with elevated total cholesterol (≥200 mg/dL) was 27% in men and 34% in women. Conclusions —Recommended guidelines of blood pressure, total cholesterol, and LDL cholesterol effectively predict CHD risk in a middle-aged white population sample. A simple coronary disease prediction algorithm was developed using categorical variables, which allows physicians to predict multivariate CHD risk in patients without overt CHD.

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Tài liệu tham khảo

10.1056/NEJM199604043341403

10.1016/0002-8703(82)90567-1

10.2337/diacare.2.2.120

10.7326/0003-4819-87-4-393

The Expert Panel. Report of the National Cholesterol Education Program Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults. Arch Intern Med. 1988;34:193–201.

10.1001/jama.1993.03500230097036

10.1161/circ.89.3.8124825

10.1016/0002-8703(91)90861-B

10.1001/jama.1993.03500230097036

10.1001/archinte.1993.00410020010002

Anderson KM, Wilson PWF, Odell PM, Kannel WB. An updated coronary risk profile: a statement for health professionals. Circulation. 1991;83:357–363.

10.1093/oxfordjournals.aje.a112813

10.1016/S0021-9258(19)50907-3

Lipid Research Clinics Program. Manual of Laboratory Operation. Bethesda Md: National Institutes of Health; 1974:75–628.

10.1093/clinchem/18.6.499

Manual of Laboratory Operations: Lipid Research Clinics Program Lipid and Lipoprotein Analysis. Washington DC: National Institutes of Health US Department of Health and Human Services; 1982.

Kannel WB Wolf PA Garrison RJ. Monograph Section 34: Some Risk Factors Related to the Annual Incidence of Cardiovascular Disease and Death Using Pooled Repeated Biennial Measurements: Framingham Heart Study 30-Year Followup. Springfield Mass: National Technical Information Service; 1987:1–459.

Neter J Wasserman W. Multiple regression. In: Applied Linear Statistical Models. Homewood Ill: Irwin; 1974:214–272.

Cox DR. Regression models and life tables. J R Stat Soc B. 1972;34:187–220.

10.1002/(SICI)1097-0258(19960229)15:4<361::AID-SIM168>3.0.CO;2-4

10.1001/jama.1990.03440030080025

Wilson PWF, Castelli WP, Kannel WB. Coronary risk prediction in adults: the Framingham Heart Study. Am J Cardiol. 1987;59:91–94.

10.1001/jama.1995.03530070037026

Wilson PWF, Kannel WB. Hypercholesterolemia and coronary risk in the elderly: the Framingham Study. Am J Geriat Cardiol. 1993;2:52–56.

10.1093/clinchem/36.1.36

10.1093/clinchem/41.2.232

10.7326/0003-4819-114-3-224

10.1001/jama.1992.03480060062031

10.1001/jama.1995.03530100041032

10.1016/S0140-6736(95)91792-6

10.1001/jama.1992.03480120090039

10.1001/archinte.1995.00430200017004

10.1001/jama.1987.03390230069027

The 4S Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344:1383–1389.

10.1056/NEJM199511163332001

10.1016/0002-8703(90)90216-K

10.7326/0003-4819-118-12-199306150-00008

10.1001/jama.1987.03400090067035

10.1016/0002-8703(90)90026-T

10.1016/0895-4356(94)00191-R

Pasley BH, Standfast SJ, Katz SH. Prescribing estrogen during menopause: physician survey of practices in 1974 and 1981. Public Health Rep. 1984;99:424–429.

10.1001/jama.1983.03330310033022

10.1001/jama.1991.03460140089033

10.1056/NEJM199109123251102

10.1016/0091-7435(91)90006-P

10.1056/NEJM198510243131702

Eaker ED Castelli WP. Coronary heart disease and its risk factors among women in the Framingham Study. In: Eaker ED Packard B Wenger NK Clarkson TB Tyroler HA eds. Coronary Heart Disease in Women. New York NY: Haymarket Doyma Inc; 1987:122–130.

Petitti DB. Reporting results. In: Meta-Analysis Decision Analysis and Cost-Effectiveness Analysis. New York NY: Oxford; 1994:197–211.

10.1146/annurev.pu.08.050187.001345

10.1001/jama.1995.03520390039030

10.1093/oxfordjournals.aje.a115704

Wilson PWF. High-density lipoprotein low-density lipoprotein and coronary artery disease. Am J Cardiol. 1990;66(suppl A):7–10.

10.1016/0021-9150(87)90094-3

10.1056/NEJM199107183250302

10.1161/atvb.15.12.2213

Wood PD. Physical activity, diet, and health: independent and interactive effects. Med Sci Sports Exerc. 1994;26:838–843.

10.1093/oxfordjournals.aje.a115126

10.1016/S0026-0495(76)80008-X

10.1016/0021-9681(74)90013-7

McGee D T Gordon. The Framingham Study applied to four other U. S. based epidemiological studies of cardiovascular disease (Section No. 31). Bethesda Md: US Department of Health Education and Welfare NIH; 1976:76–1083.

10.1161/circ.53.2.1245042

10.1016/0021-9681(87)90129-9

10.1016/0021-9681(77)90013-3

10.1016/S0140-6736(96)05516-X

10.1016/S0140-6736(96)04292-4

10.7326/0003-4819-121-9-199411010-00002

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Ovid Technologies (Wolters Kluwer Health)

Tập 97 Số 18

1837-1847

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