Prognostic validation of a non-laboratory and a laboratory based cardiovascular disease risk score in multiple regions of the world. Issue 7 (24th October 2017)

• Record Type: Journal Article
• 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 S;
• Is Part Of: Heart. Volume 104:Issue 7(2018)
• Page Start: 581
• Page End: 587
• Publication Date: 2017-10-24
• Subjects: cardiovascular disease -- risk prediction -- INTERHEART risk score; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2017-311609
• Languages: English
• ISSNs: 1355-6037

Abstract

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.