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. 2023 Apr 28;23(1):217.
doi: 10.1186/s12872-023-03235-6.

A nomogram based on endothelial function and conventional risk factors predicts coronary artery disease in hypertensives

Xiao-Dong Huang  1   2   3 , Ji-Yan Lin  1   3 , Xian-Wei Huang  1   3 , Ting-Ting Zhou  4 , Liang-Di Xie  5   6
Affiliations

A nomogram based on endothelial function and conventional risk factors predicts coronary artery disease in hypertensives

Xiao-Dong Huang et al. BMC Cardiovasc Disord. .

Abstract

Background: There is currently a lack of a precise, concise, and practical clinical prediction model for predicting coronary artery disease (CAD) in patients with essential hypertension (EH). This study aimed to construct a nomogram to predict CAD in patients with EH based on flow-mediated dilation (FMD) of brachial artery and traditional risk factors.

Methods: Clinical data of 1752 patients with EH were retrospectively collected. High-resolution vascular ultrasound was used to detect FMD in all patients at the Fujian Hypertension Research Institute, China. Patients were divided into two groups, i.e. training group (n = 1204, from August 2000 to December 2013) and validation group (n = 548, from January 2014 to May 2016) according to the time of enrollment. Independent predictors of CAD were analyzed by multivariable logistic regression in the training group, and a nomogram was constructed accordingly. Finally, we evaluated the discrimination, calibration, and clinical applicability of the model using the area under curve (AUC) of receiver operating characteristic analysis, calibration curve combined with Hosmer-Lemeshow test, and decision curve, respectively.

Results: There were 263 (21.8%) cases of EH combined with CAD in the training group. Multivariate logistic regression showed that FMD, age, duration of EH, waist circumference, and diabetes mellitus were independent influencing factors for CAD in EH patients. Smoking which was close to statistical significance (P = 0.062) was also included in the regression model to increase the accuracy. Ultimately, the nomogram for predicting CAD in EH patients was constructed according to above predictors after proper transformation. The AUC values of the training group and the validation group were 0.799 (95%CI 0.770-0.829) and 0.836 (95%CI 0.787-0.886), respectively. Calibration curve and Hosmer-Lemeshow test showed that the model had good calibration (training group: χ2 = 0.55, P = 0.759; validation group: χ2 = 1.62, P = 0.446). The decision curve also verified the clinical applicability of the nomogram.

Conclusion: The nomogram based on FMD and traditional risk factors (age, duration of EH disease, smoking, waist circumference and diabetes mellitus) can predict CAD high-risk group among patients with EH.

Keywords: Coronary artery disease; Endothelial function; Essential hypertension; Flow-mediated dilation; Nomogram.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Flow chart of participant selection in this study. Abbreviations: CAD, coronary artery disease; FMD, flow-mediated dilation
Fig. 2
Fig. 2
The CAD risk nomogram was developed using the predictors, including FMD and traditional risk factors. CAD, coronary artery disease; FMD, flow-mediated dilation
Fig. 3
Fig. 3
ROC curves for predicting essential hypertension complicated with coronary artery disease in training group (A) and validation group (B)
Fig. 4
Fig. 4
Calibration curves of training (A) and validation (B) groups. The diagonal dotted line represents the ideal curve, the solid line represents the bias-correction curve, and the dashed line represents the apparent curve
Fig. 5
Fig. 5
Decision curve analyses of training (A) and validation groups (B)
See this image and copyright information in PMC

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