The ACC/AHA 2013 pooled cohort equations compared to a Korean Risk Prediction Model for atherosclerotic cardiovascular disease. Issue 1 (September 2015)

• Record Type: Journal Article
• Authors: Jung, Keum Ji; Jang, Yangsoo; Oh, Dong Joo; Oh, Byung-Hee; Lee, Sang Hoon; Park, Seong-Wook; Seung, Ki-Bae; Kim, Hong-Kyu; Yun, Young Duk; Choi, Sung Hee; Sung, Jidong; Lee, Tae-Yong; Kim, Sung hi; Koh, Sang Baek; Kim, Moon Chan; Chang Kim, Hyeon; Kimm, Heejin; Nam, Chungmo; Park, Sungha; Jee, Sun Ha
• Is Part Of: Atherosclerosis. Volume 242:Issue 1(2015)
• Page Start: 367
• Page End: 375
• Publication Date: 2015-09
• Subjects: Prediction -- Validation -- Atherosclerotic cardiovascular disease -- Cohort study; Arteriosclerosis -- Periodicals; Electronic journals; 616.136
• DOI: 10.1016/j.atherosclerosis.2015.07.033
• Languages: English
• ISSNs: 0021-9150

Abstract

Abstract: Background and aims: To evaluate the performance of the American College of Cardiology/American Heart Association (ACC/AHA) 2013 Pooled Cohort Equations in the Korean Heart Study (KHS) population and to develop a Korean Risk Prediction Model (KRPM) for atherosclerotic cardiovascular disease (ASCVD) events. Methods: The KHS cohort included 200, 010 Korean adults aged 40–79 years who were free from ASCVD at baseline. Discrimination, calibration, and recalibration of the ACC/AHA Equations in predicting 10-year ASCVD risk in the KHS cohort were evaluated. The KRPM was derived using Cox model coefficients, mean risk factor values, and mean incidences from the KHS cohort. Results: In the discriminatory analysis, the ACC/AHA Equations' White and African–American (AA) models moderately distinguished cases from non-cases, and were similar to the KRPM: For men, the area under the receiver operating characteristic curve (AUROCs) were 0.727 (White model), 0.725 (AA model), and 0.741 (KRPM); for women, the corresponding AUROCs were 0.738, 0.739, and 0.745. Absolute 10-year ASCVD risk for men in the KHS cohort was overestimated by 56.5% (White model) and 74.1% (AA model), while the risk for women was underestimated by 27.9% (White model) and overestimated by 29.1% (AA model). Recalibration of the ACC/AHA Equations did not affect discriminatory ability but improved calibration substantially, especially in men in the White model. Of the three ASCVD risk prediction models, the KRPM showed best calibration. Conclusions: The ACC/AHA Equations should not be directly applied for ASCVD risk prediction in a Korean population. The KRPM showed best predictive ability for ASCVD risk. Highlights: The Korean Heart Study cohort included 200, 010 Korean adults aged 40–79 years at baseline. We evaluated the calibration and discrimination of the ACC/AHA 2013 Pooled Cohort Equations in predicting ASCVD risk. ASCVD risk in Korea was overestimated by the ACC/AHA risk equations. Exception was that the White model for women underestimated. The Korean Risk Prediction Model showed best predictive capability for ASCVD risk.