Quantifying Importance of Major Risk Factors for Coronary Heart Disease

作者：Michael Pencina, Ann Marie Návar, Daniel Wojdyla, Robert J. Sanchez, Irfan Khan, Joseph Elassal, Ralph B. D’Agostino, Eric D. Peterson, Allan D. Sniderman · 发表于：Circulation · 年份：2019 · DOI：10.1161/circulationaha.117.031855 · 被引用次数：252 · 研究领域：Cardiovascular Health and Risk Factors、Lipoproteins and Cardiovascular Health、Diabetes, Cardiovascular Risks, and Lipoproteins

BACKGROUND: To optimize preventive strategies for coronary heart disease (CHD), it is essential to understand and appropriately quantify the contribution of its key risk factors. Our objective was to compare the associations of key modifiable CHD risk factors-specifically lipids, systolic blood pressure (SBP), diabetes mellitus, and smoking-with incident CHD events based on their prognostic performance, attributable risk fractions, and treatment benefits, overall and by age. METHODS: Pooled participant-level data from 4 observational cohort studies sponsored by the National Heart, Lung, and Blood Institute were used to create a cohort of 22 626 individuals aged 45 to 84 years who were initially free of cardiovascular disease. Individuals were followed for 10 years from baseline evaluation for incident CHD. Proportional hazards regression was used to estimate metrics of prognostic model performance (likelihood ratio, C index, net reclassification, discrimination slope), hazard ratios, and population attributable fractions for SBP, non-high-density lipoprotein cholesterol (non-HDL-C), diabetes mellitus, and smoking. Expected absolute risk reductions for antihypertensive and lipid-lowering treatment were assessed. RESULTS: Age, sex, and race capture 63% to 80% of the prognostic performance of cardiovascular risk models. In contrast, adding either SBP, non-HDL-C, diabetes mellitus, or smoking to a model with other risk factors increases the C index by only 0.004 to 0.013. However...