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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

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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