Model for Assessing Cardiovascular Risk in a Korean Population

Abstract

During the past decades, cardiovascular disease (CVD) has rapidly increased in Asian countries and about half of the worldwide burden of CVD is carried in these countries. 1,2 Therefore, CVD prevention in Asia has been an important issue for world health. 3 In the guideline, tailored approaches by risk stratification of asymptomatic people using global risk scores have become an accepted method for the primary prevention of CVD. 4,5 However, effectiveness of existing CVD risk models, developed on the basis of the database of Western countries, was rarely validated for Asian populations. 6 In addition, a risk prediction model, considering the race or ethnic differences of risk factors attributable to development of CVD in Asian populations, is limited. 3,7 Atherosclerotic disease is rarely confined to the coronary arteries and thus the CVD risk factors are largely the same as those for coronary heart disease (CHD). 8 In addition to the standard Framingham risk factors of age, sex, diabetes mellitus, smoking, blood pressure, and cholesterol, 9,10 recently developed prediction models showed that CVD risk also relates to parental history of myocardial infarction (MI), inflammatory biomarkers, such as high-sensitivity C-reactive protein (hsCRP), and markers of glycemic control such as Background-A model for predicting cardiovascular disease in Asian populations is limited. Methods and Results-In total, 57 393 consecutive asymptomatic Korean individuals aged 30 to 80 years without a prior history of cardiovascular disease who underwent a general health examination were enrolled. Subjects were randomly classified into the train (n=45 914) and validation (n=11 479) cohorts. Thirty-one possible risk factors were assessed. The cardiovascular event was a composite of cardiovascular death, myocardial infarction, and stroke. In the train cohort, the C-index (95% confidence interval) and Akaike Information Criterion were used to develop the best-fitting prediction model. In the validation cohort, the predicted versus the observed cardiovascular event rates were compared by the C-index and Nam and D'Agostino χ 2 statistics. During a median follow-up period of 3.1 (interquartile range, 1.9-4.3) years, 458 subjects had 474 cardiovascular events. In the train cohort, the best-fitting model consisted of age, diabetes mellitus, hypertension, current smoking, family history of coronary heart disease, white blood cell, creatinine, glycohemoglobin, atrial fibrillation, blood pressure, and cholesterol (C-index =0.757 [0.726-0.788] and Akaike Information Criterion =7207). When this model was tested in the validation cohort, it performed well in terms of discrimination and calibration abilities (C-index=0.760 [0.693-0.828 To address these issues, we developed and validated a risk model to predict global cardiovascular risk using standard risk factors and possible biomarkers in a large cohort of asymptomatic Korean individuals. Methods Data SourcesIn total, 91 636 consecutive South Korean individuals aged 30 to 80 years who had undergone...

Anatomic or Functional Evaluation as an Initial Test for Stable Coronary Artery Disease: A Propensity Score Analysis

“…Therefore, considering the nationwide situation in clinical practices, this present study was designed. Well-controlled and reliable data from the HIRA database in Korea (i.e., a quasigovernmental organization) enabled qualified analyses of clinical outcomes after the initial analysis for stable CAD (14).…”

“…The HIRA is a quasigovernmental organization that systematically reviews medical fees to minimize the risk of redundant and unnecessary medical services. Consequently, all NHI claims are reviewed by the HIRA (14). In this present study, data from 2009-2013 claims records of the HIRA were used.…”

“…Diagnosis codes were used in the International Classification of Diseases, 10th Revision (ICD-10) (15). Procedures are identified by codes from the HIRA database (14).…”

“…MI was defined using the hospital discharge databases of the HIRA (ICD-10 codes I21.X-22.X). Coronary revascularizations in the HIRA database were identified using the procedure codes of percutaneous coronary intervention (M6551, M6552, M6561-4, M6571, and M6572) and coronary artery bypass surgery (O1641, O1642, O1647, OA641, OA642, and OA647) (14). In this current study, to evaluate clinical outcomes, the HIRA database was used until December 2013.…”

Model for Predicting Cardiovascular Disease: Insights from a Korean Cardiovascular Risk Model

“…We have recently published a study performed to develop a risk model to predict global cardiovascular risk in a large cohort of asymptomatic Korean individuals [6] . In addition, we sought in that study to evaluate (a) the incidence and characteristics of CVD in a Korean population, (b) the racial or ethnic differences of risk factors attributable to the development of CVD, and (c) the validation of existing CVD risk models developed on the basis of a database of Western populations.…”