Improving Global Vascular Risk Prediction With Behavioral and Anthropometric FactorsThe Multiethnic NOMAS (Northern Manhattan Cohort Study)
Ralph L. Sacco, MD, MS*,*,
Minesh Khatri, MD ,
Tatjana Rundek, MD, PhD*,
Qiang Xu, PhD ,
Hannah Gardener, ScD*,
Bernadette Boden-Albala, DrPH, ,
Marco R. Di Tullio, MD||,
Shunichi Homma, MD||,
Mitchell S.V. Elkind, MD, MS and
Myunghee C. Paik, PhD
* Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida
Department of Neurology, Columbia University, College of Physicians and Surgeons, and Mailman School of Public Health, New York, New York
Department of Biostatistics, Columbia University, College of Physicians and Surgeons, and Mailman School of Public Health, New York, New York
Department of Sociomedical Science, Columbia University, College of Physicians and Surgeons, and Mailman School of Public Health, New York, New York
|| Department of Medicine, Columbia University, College of Physicians and Surgeons, and Mailman School of Public Health, New York, New York
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Figure 1 Survival Free of Stroke, Myocardial Infarction, or Vascular Death Stratified by NOMAS Model Quartiles of GVRS
The global vascular risk score (GVRS): first quartile, 4.4 to 8.0; second quartile, 8.0 to 8.7; third quartile, 8.7 to 9.3; fourth quartile, 9.3 to 11.6. NOMAS = Northern Manhattan Study.
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Figure 2 Comparative ROCs
The receiver-operator characteristics (ROCs) for a model consisting of Framingham traditional variables, a model chosen by the Akaike Information Criterion (AIC) method (Framingham traditional variables and waist circumference and an interaction between alcohol use and physical activity [etmod*actmodheavy]), and the NOMAS GVRS. The areas under the curves are: traditional variable model, 0.736; traditional variables and waist circumference and an interaction between alcohol use and physical activity, 0.739; NOMAS GVRS, 0.747. Abbreviations as in Figure 1.
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Figure 3 Comparison of 10-Year Predicted Probabilities of GVRS
Comparison of 10-year predicted probabilities between the NOMAS GVRS and the model with traditional variables. Points above/below the dashed line are the subjects whose 10-year risk is predicted higher/lower with the NOMAS GVRS compared with the model with traditional variables. Black crosses show subjects who had events within 10 years, and red dots show those who are free of the outcome for 10 years of follow-up. The black points above and the red points below the dashed line represent correct reclassification. The crude summary proportion of correctly reclassified points by the NOMAS GVRS compared with the Framingham method was 54.8%. The summary statistic (weighted versions of the integrated discrimination improvement measures proposed by Pencina et al. [24]) between the NOMAS model and the traditional variables model is 8.66, and the p value computed from the bootstrap procedure is 0.055. Abbreviations as in Figure 1.
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Figure 4 Calibration by Decile for NOMAS GVRS
Comparison of 10-year Kaplan-Meier–based (blue bars) and NOMAS model–based (decile-specific means, brown bars) predicted probabilities of stroke, myocardial infarction, or vascular death events by deciles of the NOMAS GVRS. Abbreviations as in Figure 1.
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Figure 5 Internet-Based Screen for Entry of GVRS
From the Department of Neurology, Miller School of Medicine, University of Miami web site (26). ACE = angiotensin-converting enzyme; ARB = angiotensin receptor blocker; HDL = high-density lipoprotein; MI = myocardial infarction; other abbreviations as in Figure 1.
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