Prognostic validation of a non-laboratory and a laboratory based cardiovascular disease risk score in multiple regions of the world Academic Article uri icon

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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.

authors

  • Joseph, Philip
  • Yusuf, Salim
  • Lee, Shun Fu
  • Ibrahim, Quazi
  • Teo, Koon
  • Rangarajan, Sumathy
  • Gupta, Rajeev
  • Rosengren, Annika
  • Lear, Scott A
  • Avezum, Alvaro
  • Lopez-Jaramillo, Patricio
  • Gulec, Sadi
  • Yusufali, Afzalhussein
  • Chifamba, Jephat
  • Lanas, Fernando
  • Kumar, Rajesh
  • Mohammadifard, Noushin
  • Mohan, Viswanathan
  • Mony, Prem
  • Kruger, Annamarie
  • Liu, Xu
  • Guo, Baoxia
  • Zhao, Wenqi
  • Yang, Youzhu
  • Pillai, Rajamohanan
  • Diaz, Rafael
  • Krishnapillai, Ambigga
  • Iqbal, Romaina
  • Yusuf, Rita
  • Szuba, Andrzej
  • Anand, Sonia

publication date

  • April 2018