Framingham score and LV mass predict events in young adults: CARDIA study

被引:67
作者
Armstrong, Anderson C. [1 ,2 ]
Jacobs, David R., Jr. [3 ]
Gidding, Samuel S. [4 ]
Colangelo, Laura A. [5 ]
Gjesdal, Ola [1 ]
Lewis, Cora E. [6 ]
Bibbins-Domingo, Kirsten [7 ]
Sidney, Stephen [8 ]
Schreiner, Pamela J. [3 ]
Williams, O. D. [9 ]
Goff, David C., Jr. [10 ]
Liu, Kiang [5 ]
Lima, Joao A. C. [1 ]
机构
[1] Johns Hopkins Univ, Baltimore, MD 21287 USA
[2] Univ Fed Vale Sao Francisco, Petrolina, PE, Brazil
[3] Univ Minnesota, Minneapolis, MN USA
[4] Alfred I DuPont Hosp Children, Nemours Cardiac Ctr, Wilmington, DE USA
[5] Northwestern Univ, Chicago, IL 60611 USA
[6] Univ Alabama Birmingham, Birmingham, AL USA
[7] Univ Calif San Francisco, San Francisco, CA 94143 USA
[8] Kaiser Permanente Div Res, Oakland, CA USA
[9] Florida Int Univ, Miami, FL 33199 USA
[10] Colorado Sch Publ Hlth, Aurora, CO USA
基金
美国国家卫生研究院;
关键词
Young adults; Cardiovascular risk; Left ventricular hypertrophy; Echocardiography; LEFT-VENTRICULAR MASS; POPULATION-ATTRIBUTABLE RISK; CORONARY-HEART-DISEASE; CARDIOVASCULAR RISK; MAGNETIC-RESONANCE; BODY-SIZE; HYPERTROPHY; OBESITY; STROKE; ECHOCARDIOGRAPHY;
D O I
10.1016/j.ijcard.2014.01.003
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Framingham risk score (FRS) underestimates risk in young adults. Left ventricular mass (LVM) relates to cardiovascular disease (CVD), with unclear value in youth. In a young biracial cohort, we investigate how FRS predicts CVD over 20 years and the incremental value of LVM. We also explore the predictive ability of different cut-points for hypertrophy. Methods: We assessed FRS and echocardiography-derived LVM(indexed by body surface area or height(2.7)) from 3980 African-American and white Coronary Artery Risk Development in Young Adults (CARDIA) participants (1990-1991); and followed over 20 years for a combined endpoint: cardiovascular death; nonfatal myocardial infarction, heart failure, cerebrovascular disease, and peripheral artery disease. Weassessed the predictive ability of FRS for CVD and also calibration, discrimination, and net reclassification improvement for adding LVM to FRS. Results: Mean age was 30 +/- 4 years, 46% males, and 52% white. Event incidence (n = 118) across FRS groups was, respectively, 1.3%, 5.4%, and 23.1% (p < 0.001); and was 1.4%, 1.3%, 3.7%, and 5.4% (p < 0.001) across quartiles of LVM(cut-points 117 g, 144 g, and 176 g). LVMpredicted CVD independently of FRS, with the best performance in normal weight participants. Adding LVM to FRS modestly increased discrimination and had a statistically significant reclassification. The 85th percentile (>= 116 g/m(2) formen; >= 96 g/m(2) for women) showed event prediction more robust than currently recommended cut-points for hypertrophy. Conclusion: In a biracial cohort of young adults, FRS and LVM are helpful independent predictors of CVD. LVM can modestly improve discrimination and reclassify participants beyond FRS. Currently recommended cut-points for hypertrophy may be too high for young adults. (C) 2014 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:350 / 355
页数:6
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