Tang X, Zhang D D, He L, Cao Y, Wang J W, Li N, Huang S P, Dou H D, Gao P, Hu Y H
Department of Epidemiology & Biostatistics, Peking University School of Public Health, Beijing 100191, China.
Fangshan District Bureau of Health, Beijing 102488, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2017 Jun 18;49(3):439-445.
To validate five-year risk prediction models for atherosclerotic cardiovascular disease (ASCVD) in a contemporary rural Northern Chinese population.
Totally 6 489 rural adults aged 40 to 79 years without clinical ASCVD were enrolled at baseline between June and August 2010, and followed up through January 2017. Expected prediction risk using the China-PAR (prediction for ASCVD risk in China) model was compared with the pooled cohort equations (PCE) reported in the American College of Cardiology/American Heart Association guideline. Kaplan-Meier analysis was used to obtain the observed ASCVD event (including nonfatal myocardial infarction, coronary heart disease death, nonfatal or fatal stroke) rate at 5 years, and the expected-observed ratios were calculated to eva-luate overestimation or underestimation in the cohort. The participants in the cohort were divided into 4 categories (<5.0%, 5.0%-7.4%, 7.5%-9.9%, and ≥10.0%) for comparisons based on ASCVD prediction risk. The models were assessed by discrimination C statistic, calibration χ, and calibration charts and plots for illustration as well.
Over an average 5.82 years of follow-up in this validation cohort with 6 489 rural Chinese participants, 955 subjects developed a first ASCVD event. Recalibrated China-PAR model overestimated ASCVD events by 22.2% in men and 33.1% in women, while the overestimations were much higher for recalibrated PCE as 67.3% in men and 53.1% in women. Gender-specific China-PAR model had C statistics of 0.696 (95%CI, 0.669-0.723) for men and 0.709 (95%CI, 0.690-0.728) for women, which were similar to those of 0.702 (95%CI, 0.675-0.730) for men and 0.714 (95%CI, 0.695-0.733) for women in the PCE. Calibration χ values in China-PAR were 17.2 and 54.2 for men and women, respectively; however, the PCE showed poorer ca-libration (χ=192.0 for men and χ=181.2 for women). In addition, the calibration charts and plots illustrated good agreement between the observations and the predictions only in the China-PAR model, especially for men.
In this validation cohort of rural Northern Chinese adults, the China-PAR model had better performance of five-year ASCVD risk prediction than the PCE, indicating that recalibrated China-PAR model might be an appropriate tool for risk assessment and primary prevention of ASCVD in China.
在中国北方当代农村人群中验证动脉粥样硬化性心血管疾病（ASCVD）的五年风险预测模型。
2010年6月至8月期间，共纳入6489名年龄在40至79岁之间、无临床ASCVD的农村成年人作为基线研究对象，并随访至2017年1月。将使用中国-PAR（中国ASCVD风险预测）模型得出的预期预测风险与美国心脏病学会/美国心脏协会指南中报告的合并队列方程（PCE）进行比较。采用Kaplan-Meier分析得出5年时观察到的ASCVD事件（包括非致命性心肌梗死、冠心病死亡、非致命性或致命性卒中）发生率，并计算预期-观察比率，以评估队列中的高估或低估情况。根据ASCVD预测风险，将队列中的参与者分为4类（<5.0%、5.0%-7.4%、7.5%-9.9%和≥10.0%）进行比较。通过鉴别C统计量、校准χ²以及校准图表和绘图对模型进行评估。
在这个包含6489名中国农村参与者的验证队列中，平均随访5.82年，955名受试者发生了首次ASCVD事件。重新校准后的中国-PAR模型在男性中高估ASCVD事件22.2%，在女性中高估33.1%，而重新校准后的PCE高估情况更高，男性为67.3%，女性为53.1%。特定性别的中国-PAR模型在男性中的C统计量为0.696（95%CI，0.669-0.723），在女性中的C统计量为0.709（95%CI，0.690-0.728），与PCE中男性的0.702（95%CI，0.675-0.730）和女性的0.714（95%CI，0.695-0.733）相似。中国-PAR模型中男性和女性的校准χ²值分别为17.2和54.2；然而，PCE的校准情况较差（男性χ²=192.0，女性χ²=181.2）。此外，校准图表和绘图显示仅在中国-PAR模型中观察值与预测值之间具有良好的一致性，尤其是在男性中。
在这个中国北方农村成年人的验证队列中，中国-PAR模型在五年ASCVD风险预测方面的表现优于PCE，表明重新校准后的中国-PAR模型可能是中国ASCVD风险评估和一级预防的合适工具。
