与传统评分相比,冠状动脉钙评分(CACS)和多基因风险评分已被用作新的标志物来预测无症状个体的心血管(CV)事件。以前的研究没有直接比较这两种标记物相对于常规评分的累加能力。
目的:评估CACS时CV风险预测能力的变化,遗传风险评分(GRS)或两者都添加到SCORE2中。
方法:前瞻性,基于人群的观察性研究,涉及1002名无症状受试者(平均年龄53.1±6.8岁,73.8%男性),没有临床冠心病和糖尿病,从GENEMACOR研究对照中选择。SCORE2,CACS和GRS通过Harrell的C统计量评估了CV事件的预测和辨别能力。使用净重新分类改进(NRI)和综合歧视指数对人群进行重新分类。多变量Cox比例风险比(HR)分析评估了与CV事件独立相关的变量。
结果:C统计量表明,SCORE2对CV事件发生的判别值为0.608,当添加CACS时增加到0.749(p=0.001),用GRS提高到0.802(p=0.0008),对CV事件表现出更好的判别能力。连续NRI重新分类>70%的人口。Cox比例分析表明,最高类别的SCORE2,CACS和GRS保持在方程中,HR为2.9(p=0.003),5.0(p<0.0001)和3.2(p=0.003),分别,与最低类别相比。
结论:在我们的人群中,在CV事件风险预测中,SCORE2添加CACS比GRS具有更好的能力,歧视和重新分类。然而,加上这三个分数可以变得临床相关,尤其是中等风险人群。
我们的研究强调了在一级预防中加入CACS和GRS以及SCORE2对增强心血管风险评估的影响。在我们的人口中,在风险预测方面,与单独的GRS相比,将CACS添加到SCORE2对CV事件具有更好的判别能力,歧视,和重新分类。我们的结果强调了使用所有三个分数来识别高风险个体的潜在临床相关性,谁将受益于更早和更严格的心血管风险管理策略,以预防未来的心血管事件。
OBJECTIVE: Coronary artery calcium score (CACS) and polygenic risk score have been used as novel markers to predict cardiovascular (CV) events of asymptomatic individuals compared with traditional scores. No previous studies have directly compared the additive capacity of these two markers relative to conventional scores. The aim of the study was to evaluate the change in CV risk prediction ability when CACS, genetic risk score (GRS), or both are added to Systematic Coronary Risk Evaluation 2 (SCORE2).
RESULTS: In a prospective, observational population-based study, 1002 asymptomatic subjects (mean age 53.1 ± 6.8 years, 73.8% male), free of clinical coronary disease and diabetes, were selected from GENEMACOR-study controls. SCORE2, CACS, and GRS were estimated to evaluate CV events\' predictive and discriminative ability through Harrell\'s C-statistics. Net reclassification improvement (NRI) and integrated discrimination index were used to reclassify the population. Multivariable Cox proportional hazard ratio (HR) analysis assessed the variables independently associated with CV events. C-statistic demonstrated that the discriminative value for CV event occurrence was 0.608 for SCORE2, increasing to 0.749 (P = 0.001) when CACS was added, and improved to 0.802 (P = 0.0008) with GRS, showing a better discriminative capacity for CV events. Continuous NRI reclassified >70% of the population. Cox proportional analysis showed that the highest categories of SCORE2, CACS, and GRS remained in the equation with an HR of 2.9 (P = 0.003), 5.0 (P < 0.0001), and 3.2 (P = 0.003), respectively, when compared with the lowest categories.
CONCLUSIONS: In our population, CACS added to SCORE2 had better ability than GRS in CV event risk prediction, discrimination, and reclassification. However, adding the three scores can become clinically relevant, especially in intermediate-risk persons.
Our study highlights the impact of including coronary artery calcium score (CACS) and genetic risk score (GRS) alongside Systematic Coronary Risk Evaluation 2 (SCORE2) for enhancing cardiovascular (CV) risk assessment in primary prevention. In our population, adding CACS to SCORE2 exhibited a superior discriminative capacity for CV events compared with GRS alone in terms of risk prediction, discrimination, and reclassification. Our results emphasize the potential clinical relevance of using all three scores to identify high-risk individuals who would benefit from earlier and more stringent cardiovascular risk management strategies to prevent future cardiovascular events.