背景:目前在英国,心血管疾病(CVD)风险评估基于QRISK3评分,其中10%的10年CVD风险表明临床干预。然而,这一基准在临床实践中疗效有限,需要更简单的方法,非侵入性风险分层工具是必要的。视网膜摄影作为CVD的非侵入性成像工具正变得越来越可接受。以前,我们开发了一种基于预测未来CVD风险的视网膜照片的新型CVD风险分层系统.这项研究旨在进一步验证我们的生物标志物,Reti-CVD,(1)在10年CVD风险中检测≥10%的风险组;(2)使用UKBiobank增强QRISK3为7.5-10%的个体(称为边界QRISK3组)的风险评估。
方法:根据来自英国生物库的优化临界值,计算Reti-CVD评分并将其分层为三个风险组。我们使用Cox比例风险模型来评估Reti-CVD预测普通人群中CVD事件的能力。C统计学用于评估在临界QRISK3组和三个易损亚组中在QRISK3中添加Reti-CVD的预后价值。
结果:在48,260名没有心血管疾病史的参与者中,6.3%的患者在11年随访期间发生了CVD事件。Reti-CVD与CVD风险增加相关(调整后风险比[HR]1.41;95%置信区间[CI],1.30-1.52),Reti-CVD高危人群的10年CVD风险为13.1%(95%CI,11.7-14.6%)。在Reti-CVD高风险组中,临界QRISK3组的10年CVD风险大于10%(非他汀类药物队列中为11.5%[n=45,473],1期高血压队列中11.5%[n=11,966],中年队列中占14.2%[n=38,941])。非他汀类药物队列中的C统计数据增加了0.014(0.010-0.017),1期高血压队列中的0.013(0.007-0.019),将Reti-CVD添加到QRISK3后,中年队列中的CVD事件预测为0.023(0.018-0.029)。
结论:Reti-CVD有可能识别10年CVD风险≥10%的个体,这些个体可能从早期的预防性CVD干预中获益。对于10年CVD风险在7.5%至10%之间的临界QRISK3个体,Reti-CVD可以用作风险增强工具,以帮助提高识别准确性,尤其是在可能倾向于CVD的成人群体中。
Currently in the United Kingdom, cardiovascular disease (CVD) risk assessment is based on the QRISK3 score, in which 10% 10-year CVD risk indicates clinical intervention. However, this benchmark has limited efficacy in clinical practice and the need for a more simple, non-invasive risk stratification tool is necessary. Retinal photography is becoming increasingly acceptable as a non-invasive imaging tool for CVD. Previously, we developed a novel CVD risk stratification system based on retinal photographs predicting future CVD risk. This study aims to further validate our biomarker, Reti-CVD, (1) to detect risk group of ≥ 10% in 10-year CVD risk and (2) enhance risk assessment in individuals with QRISK3 of 7.5-10% (termed as borderline-QRISK3 group) using the UK Biobank.
Reti-CVD scores were calculated and stratified into three risk groups based on optimized cut-off values from the UK Biobank. We used Cox proportional-hazards models to evaluate the ability of Reti-CVD to predict CVD events in the general population. C-statistics was used to assess the prognostic value of adding Reti-CVD to QRISK3 in borderline-QRISK3 group and three vulnerable subgroups.
Among 48,260 participants with no history of CVD, 6.3% had CVD events during the 11-year follow-up. Reti-CVD was associated with an increased risk of CVD (adjusted hazard ratio [HR] 1.41; 95% confidence interval [CI], 1.30-1.52) with a 13.1% (95% CI, 11.7-14.6%) 10-year CVD risk in Reti-CVD-high-risk group. The 10-year CVD risk of the borderline-QRISK3 group was greater than 10% in Reti-CVD-high-risk group (11.5% in non-statin cohort [n = 45,473], 11.5% in stage 1 hypertension cohort [n = 11,966], and 14.2% in middle-aged cohort [n = 38,941]). C statistics increased by 0.014 (0.010-0.017) in non-statin cohort, 0.013 (0.007-0.019) in stage 1 hypertension cohort, and 0.023 (0.018-0.029) in middle-aged cohort for CVD event prediction after adding Reti-CVD to QRISK3.
Reti-CVD has the potential to identify individuals with ≥ 10% 10-year CVD risk who are likely to benefit from earlier preventative CVD interventions. For borderline-QRISK3 individuals with 10-year CVD risk between 7.5 and 10%, Reti-CVD could be used as a risk enhancer tool to help improve discernment accuracy, especially in adult groups that may be pre-disposed to CVD.