From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China.
Circulation. 2016 Nov 8;134(19):1430-1440. doi: 10.1161/CIRCULATIONAHA.116.022367. Epub 2016 Sep 28.
The accurate assessment of individual risk can be of great value to guiding and facilitating the prevention of atherosclerotic cardiovascular disease (ASCVD). However, prediction models in common use were formulated primarily in white populations. The China-PAR project (Prediction for ASCVD Risk in China) is aimed at developing and validating 10-year risk prediction equations for ASCVD from 4 contemporary Chinese cohorts.
Two prospective studies followed up together with a unified protocol were used as the derivation cohort to develop 10-year ASCVD risk equations in 21 320 Chinese participants. The external validation was evaluated in 2 independent Chinese cohorts with 14 123 and 70 838 participants. Furthermore, model performance was compared with the Pooled Cohort Equations reported in the American College of Cardiology/American Heart Association guideline.
Over 12 years of follow-up in the derivation cohort with 21 320 Chinese participants, 1048 subjects developed a first ASCVD event. Sex-specific equations had C statistics of 0.794 (95% confidence interval, 0.775-0.814) for men and 0.811 (95% confidence interval, 0.787-0.835) for women. The predicted rates were similar to the observed rates, as indicated by a calibration χ of 13.1 for men (P=0.16) and 12.8 for women (P=0.17). Good internal and external validations of our equations were achieved in subsequent analyses. Compared with the Chinese equations, the Pooled Cohort Equations had lower C statistics and much higher calibration χ values in men.
Our project developed effective tools with good performance for 10-year ASCVD risk prediction among a Chinese population that will help to improve the primary prevention and management of cardiovascular disease.
准确评估个体风险对于指导和促进动脉粥样硬化性心血管疾病（ASCVD）的预防具有重要价值。然而，目前常用的预测模型主要是在白种人群中建立的。中国动脉粥样硬化性心血管疾病风险预测项目（China-PAR）旨在从 4 个当代中国队列中开发和验证用于 ASCVD 的 10 年风险预测方程。
两项前瞻性研究采用统一方案进行随访，作为推导队列，共纳入 21320 例中国参与者，用于开发 10 年 ASCVD 风险方程。通过 2 个独立的中国队列（分别纳入 14123 例和 70838 例参与者）进行外部验证。此外，还将模型性能与美国心脏病学会/美国心脏协会指南中报告的 Pooled Cohort Equations 进行了比较。
在纳入 21320 例中国参与者的推导队列中，随访 12 年期间，共 1048 例患者发生首次 ASCVD 事件。男女专用方程的 C 统计量分别为 0.794（95%置信区间，0.775-0.814）和 0.811（95%置信区间，0.787-0.835）。校准 χ 检验表明，预测率与观察率之间具有良好的一致性，男性为 13.1（P=0.16），女性为 12.8（P=0.17）。进一步分析表明，我们的方程具有良好的内部和外部验证。与中国方程相比，Pooled Cohort Equations 在男性中的 C 统计量较低，而校准 χ 值较高。
本项目针对中国人群开发了性能良好的 10 年 ASCVD 风险预测有效工具，将有助于改善心血管疾病的一级预防和管理。
