Updating 10-year atherosclerotic cardiovascular risk assessment equation for Chinese adults
Miao Wang Jing Liu Wei Wang Jun Liu Jiayi Sun Yue Qi Ying Wang Yongchen Hao Lanping Qin Mengge Zhou Shen Gao Dong Zhao
Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
Objectives: To update 10-year first atherosclerotic cardiovascular disease (ASCVD) risk assessment equation for Chinese adults.
Methods: A total of 21265 Chinese aged 35 to 64 years without ASCVD who were from the Chinese Multi-Provincial Cohort Study were included in this study. The Chinese Multi-Provincial Cohort Study was a nationwide, multicenter, cohort study on the determinants in cardiovascular disease in China. The cohort was built by using multistage sampling method. The non-random and stratified random sampling methods were used, in turn, to select study centers and enroll participants. The ASCVD risk assessment equation was developed based on Cox proportional hazards regression model. The smoking status, diabetes, and natural logarithm of age, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and systolic blood pressure (SBP) were included during the equation updating. The interaction between age and risk factors was also considered. The ability of discrimination (C statistic) and calibration (calibration χ2 from Hosmere-Lemeshow test) of the equation were evaluated. The equation was also validated internally by the method of 10×10-fold cross-validation.
Results: In this study, 822 individuals experienced a first ASCVD event during the 12-year follow up. The β values of smoking status, diabetes, and natural logarithm of age, TC, HDL-C, SBP, and interaction between age and SBP were 0.09 (P=0.716), 0.51 (P=0.003), 45.91 (p<0.001), 0.39 (P=0.200), -0.60 (P=0.009), 36.90 (p<0.001), and -8.72 (p<0.001) in the risk assessment equation for the female. Compared to the female, the risk assessment equation for the male had one more interaction item (age and TC). The C statistic of the risk assessment equation was 0.769 (95% confidence interval (CI), 0.634-0.823) in females and 0.768 (95% CI, 0. 695-0.824) in males. The Hosmere-Lemeshow χ2 was 5.022 (P=0.832) in females and 9.453 (P=0.397) in males. In internal validation the average calibration χ2 was 7.276 (95CI%, 2.537-14.446) in females and 9.331 (95CI, 3.067-21.162) in males.
Conclusions: The updated 10-year first ASCVD risk assessment equation showed good performance by evaluating the ability of discrimination and calibration. Next, the equation should be developed into risk assessment tools which would make it be easily applied in the practice of ASCVD prevention.