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Prognostic Validation of a Non-Laboratory and a Laboratory Based Cardiovascular Disease Risk Score in Multiple Regions of the World Publisher Pubmed



Joseph P1 ; Yusuf S1 ; Lee SF1 ; Ibrahim Q1 ; Teo K1 ; Rangarajan S1 ; Gupta R2 ; Rosengren A3 ; Lear SA4 ; Avezum A5 ; Lopezjaramillo P6 ; Gulec S7 ; Yusufali A8 ; Chifamba J9 Show All Authors
Authors
  1. Joseph P1
  2. Yusuf S1
  3. Lee SF1
  4. Ibrahim Q1
  5. Teo K1
  6. Rangarajan S1
  7. Gupta R2
  8. Rosengren A3
  9. Lear SA4
  10. Avezum A5
  11. Lopezjaramillo P6
  12. Gulec S7
  13. Yusufali A8
  14. Chifamba J9
  15. Lanas F10
  16. Kumar R11
  17. Mohammadifard N12
  18. Mohan V13
  19. Mony P14
  20. Kruger A15
  21. Liu X16
  22. Guo B17
  23. Zhao W18
  24. Yang Y19
  25. Pillai R20
  26. Diaz R21
  27. Krishnapillai A22
  28. Iqbal R23
  29. Yusuf R24
  30. Szuba A25
  31. Anand SS1
Show Affiliations
Authors Affiliations
  1. 1. Population Health Research Institute, Hamilton Health Sciences and McMaster University, 237 Barton St East, Hamilton, L8L 2X2, ON, Canada
  2. 2. Eternal Heart Care Centre and Research Institute, Rajasthan University of Health Sciences, Fortis Escorts Hospital, Jaipur, India
  3. 3. Sahlgrenska University Hospital/Ostra Hospital, Goteborg, Sweden
  4. 4. Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
  5. 5. Dante Pazzanese Institute of Cardiology and UNISA, Sao Paulo, Brazil
  6. 6. Fundacion Oftalmologica de Santander (FOSCAL) and Medical School, Universidad de Santander (UDES), Bucaramanga, Colombia
  7. 7. School of Medicine, Ankara University, Ankara, Turkey
  8. 8. Hatta Hospital, Dubai Health Authority, Dubai Medical University, Dubai, United Arab Emirates
  9. 9. Department of Physiology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
  10. 10. Department of Internal Medicine, Universidad de la Frontera, Temuco, Chile
  11. 11. Department of Community Medicine and School of Public Health, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
  12. 12. Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  13. 13. Madras Diabetes Research Foundation, Chennai, India
  14. 14. St John's Medical College and Research Institute, Bangalore, India
  15. 15. Faculty of Health Science, North-West University, Potchefstroom, South Africa
  16. 16. Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
  17. 17. Shenyang Red Cross Hospital, Shenyang, China
  18. 18. Chinese Center for Disease Control and Prevention, Xi'ning, China
  19. 19. Huizu Hospital, Xi'ning, China
  20. 20. Health Action by People, SMCSI Medical College Karakonam, Trivandrum, India
  21. 21. Estudios Clinicos Latinoamerica ECLA, Rosario, Argentina
  22. 22. Hospital Angkatan Tentera Tuanku Mizan, Kuala Lumpur, Malaysia
  23. 23. Departments of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
  24. 24. Independent University, Bangladesh (IUB), Dhaka, Bangladesh
  25. 25. Wroclaw Medical University, Wroclaw, Poland

Source: Heart Published:2018


Abstract

Objective To evaluate the performance of the non-laboratory INTERHEART risk score (NL-IHRS) to predict incident cardiovascular disease (CVD) across seven major geographic regions of the world. The secondary objective was to evaluate the performance of the fasting cholesterol-based IHRS (FC-IHRS). Methods Using measures of discrimination and calibration, we tested the performance of the NL-IHRS (n=100 475) and FC-IHRS (n=107 863) for predicting incident CVD in a community-based, prospective study across seven geographic regions: South Asia, China, Southeast Asia, Middle East, Europe/North America, South America and Africa. CVD was defined as the composite of cardiovascular death, myocardial infarction, stroke, heart failure or coronary revascularisation. Results Mean age of the study population was 50.53 (SD 9.79) years and mean follow-up was 4.89 (SD 2.24) years. The NL-IHRS had moderate to good discrimination for incident CVD 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). Regional recalibration was also necessary for the FC-IHRS, which also improved its overall discrimination (increase in C-statistic from 0.71 to 0.74, p<0.001). In 85 078 participants with complete data for both scores, discrimination was only modestly better with the FC-IHRS compared with the NL-IHRS (0.74 vs 0.73, p<0.001). Conclusions External validations of the NL-IHRS and FC-IHRS suggest that regionally recalibrated versions of both can be useful for estimating CVD risk across a diverse range of community-based populations. CVD prediction using a non-laboratory score can provide similar accuracy to laboratory-based methods. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved.
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