Prognostic validation of a non-laboratory and a laboratory based cardiovascular disease risk score in multiple regions of the world
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Date
2018Author
Joseph, Philip
Kruger, Annamarie
Ibrahim, Quazi
Yusuf, Salim
Lee, Shun Fu
Metadata
Show full item recordAbstract
O
bjective
t
o
evaluate the performance of the non-
laboratory
i
nterheart
risk score (
n
l
-
i
hrs
)
to predict
incident cardiovascular disease (
c
V
D) across seven major
geographic regions of the world.
t
h
e secondary objective
was to evaluate the performance of the fasting cholesterol-
based
i
hrs
(F
c
-
i
hrs
)
.
Methods
U
sing measures of discrimination and calibration,
we tested the performance of the
n
l
-
i
hrs
(n=100
4
75)
and F
c
-
i
hrs
(n=107
8
63) for predicting incident
c
V
D
in a community-based, prospective study across seven
geographic regions:
s
o
uth
a
s
ia,
c
h
ina,
s
o
utheast
a
s
ia,
Middle
e
a
st,
e
u
rope/
n
o
rth
a
m
erica,
s
o
uth
a
m
erica and
a
f
rica.
c
V
D was defined as the composite of cardiovascular
death, myocardial infarction, stroke, heart failure or coronary
revascularisation.
r
e
sults
M
ean age of the study population was 50.53
(
s
D
9.79) years and mean follow-up was 4.89 (
s
D
2.24)
years.
t
h
e
n
l
-
i
hrs
had moderate to good discrimination
for incident
c
V
D across geographic regions (concordance
statistic (
c
-
statistic) ranging from 0.64 to 0.74), although
recalibration was necessary in all regions, which improved
its performance in the overall cohort (increase in
c
-
statistic
from 0.69 to 0.72, p<0.001).
r
e
gional recalibration was
also necessary for the F
c
-
i
hrs
,
which also improved its
overall discrimination (increase in
c
-
statistic from 0.71 to
0.74, p<0.001).
i
n
85
0
78 participants with complete data
for both scores, discrimination was only modestly better
with the F
c
-
i
hrs
compared with the
n
l
-
i
hrs
(0.74 vs 0.73,
p<0.001).
Conclusions
e
x
ternal validations of the
n
l
-
i
hrs
and
F
c
-
i
hrs
suggest that regionally recalibrated versions of
both can be useful for estimating
c
V
D risk across a diverse
range of community-based populations.
c
V
D prediction
using a non-laboratory score can provide similar accuracy to
laboratory-based methods
URI
http://hdl.handle.net/10394/26711http://dx.doi.org/10.1136/heartjnl-2017-311609
http://heart.bmj.com/content/heartjnl/104/7/581.full.pdf