Validation of the Atherosclerotic Cardiovascular Disease Pooled Cohort Risk Equations

作者：Paul Muntner, Lisandro D. Colantonio, Mary Cushman, David C. Goff, George Howard, Virginia J. Howard, Brett Kissela, Emily B. Levitan, Donald M. Lloyd‐Jones, Monika M. Safford · 发表于：JAMA · 年份：2014 · DOI：10.1001/jama.2014.2630 · 被引用次数：621 · 研究领域：Lipoproteins and Cardiovascular Health、Diabetes, Cardiovascular Risks, and Lipoproteins、Health Promotion and Cardiovascular Prevention

IMPORTANCE: The American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort risk equations were developed to estimate atherosclerotic cardiovascular disease (CVD) risk and guide statin initiation. OBJECTIVE: To assess calibration and discrimination of the Pooled Cohort risk equations in a contemporary US population. DESIGN, SETTING, AND PARTICIPANTS: Adults aged 45 to 79 years enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study between January 2003 and October 2007 and followed up through December 2010. We studied participants for whom atherosclerotic CVD risk may trigger a discussion of statin initiation (those without clinical atherosclerotic CVD or diabetes, low-density lipoprotein cholesterol level between 70 and 189 mg/dL, and not taking statins; n = 10,997). MAIN OUTCOMES AND MEASURES: Predicted risk and observed adjudicated atherosclerotic CVD incidence (nonfatal myocardial infarction, coronary heart disease [CHD] death, nonfatal or fatal stroke) at 5 years because REGARDS participants have not been followed up for 10 years. Additional analyses, limited to Medicare beneficiaries (n = 3333), added atherosclerotic CVD events identified in Medicare claims data. RESULTS: There were 338 adjudicated events (192 CHD events, 146 strokes). The observed and predicted 5-year atherosclerotic CVD incidence per 1000 person-years for participants with a 10-year predicted atherosclerotic CVD risk of less than 5% was 1.9 (95% CI...