Chen W Y, Liu X F, Shen P, Chen Q, Sun Y X, Wu J G, Lu P, Zhang J Y, Lin H B, Tang X, Gao Pei
Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China.
Yinzhou District Center for Disease Control and Prevention, Ningbo 315100, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2022 Aug 10;43(8):1275-1281. doi: 10.3760/cma.j.cn112338-20211206-00952.
To externally validate and compare the accuracy of the China-PAR (Prediction for ASCVD Risk in China) model and the 2019 World Health Organization (WHO) cardiovascular disease risk charts for East Asian in predicting a 10-year cardiovascular disease in a general Chinese population. Participants aged 40-79 years without prior cardiovascular disease at baseline in the CHinese Electronic health Records Research in Yinzhou (CHERRY) were analyzed. The Kaplan-Meier analysis estimated the observed cardiovascular events (including non-fatal myocardial infarction, fatal coronary heart disease, and non-fatal or fatal stroke) rate within ten years. The expected risks were calculated using the WHO risk charts for East Asia (including the laboratory-based and non-laboratory-based models) and the China-PAR model. The expected-observed ratios were calculated to evaluate the overestimation or underestimation of the models in the cohort. Model accuracy was assessed by discrimination -index, calibration value, and calibration plots. During a median of 7.26 years of follow-up, 13 301 cardiovascular events were identified among 225 811 participants. The -index for the China-PAR model, WHO laboratory-based model and WHO non-laboratory-based model were 0.741 (0.735-0.747), 0.747 (0.740-0.753), and 0.739 (0.733-0.746) for men, and 0.782 (0.776-0.788), 0.789 (0.783-0.795), and 0.782 (0.776-0.787) for women, respectively. The WHO laboratory-based model and non-laboratory-based model underestimated the 10-year ASCVD risk by around 15% in women and underestimated by 0.8% and 4.4% in men, respectively. The China-PAR model underestimated the risks by 19.5% and 42.3% for men and women. The China-PAR and WHO models all have pretty good discriminations for 10-year cardiovascular risk assessment in this general Chinese population. However, the accuracy should be improved in the highest-risk groups, suggesting further specific models are still needed for those with the highest risk, such as patients with diabetes or older persons.
为了对中国动脉粥样硬化性心血管疾病风险预测模型（China-PAR）和2019年世界卫生组织（WHO）东亚心血管疾病风险图表在预测中国普通人群10年心血管疾病风险方面的准确性进行外部验证和比较。对中国鄞州电子健康记录研究（CHERRY）中40-79岁、基线时无心血管疾病史的参与者进行了分析。采用Kaplan-Meier分析估计了10年内观察到的心血管事件（包括非致命性心肌梗死、致命性冠心病以及非致命性或致命性卒中）发生率。使用WHO东亚风险图表（包括基于实验室和非基于实验室的模型）和China-PAR模型计算预期风险。计算预期-观察比率以评估队列中模型的高估或低估情况。通过鉴别指数、校准值和校准图评估模型准确性。在中位随访7.26年期间，225811名参与者中识别出13301例心血管事件。China-PAR模型、WHO基于实验室的模型和WHO非基于实验室的模型在男性中的鉴别指数分别为0.741（0.735-0.747）、0.747（0.740-0.753）和0.739（0.733-0.746），在女性中分别为0.782（0.776-0.788）、0.789（0.783-0.795）和0.782（0.776-0.787）。WHO基于实验室的模型和非基于实验室的模型在女性中低估了约15%的10年动脉粥样硬化性心血管疾病风险，在男性中分别低估了0.8%和4.4%。China-PAR模型在男性和女性中分别低估了19.5%和42.3%的风险。China-PAR模型和WHO模型在评估中国普通人群10年心血管疾病风险方面均具有较好的鉴别能力。然而，在高危人群中准确性仍需提高，这表明对于最高风险人群，如糖尿病患者或老年人，仍需要进一步的特定模型。
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