A coronary heart disease prediction model: the Korean Heart Study

Abstract

ObjectiveThe objectives of this study were to develop a coronary heart disease (CHD) risk model among the Korean Heart Study (KHS) population and compare it with the Framingham CHD risk score.DesignA prospective cohort study within a national insurance system.Setting18 health promotion centres nationwide between 1996 and 2001 in Korea.Participants268 315 Koreans between the ages of 30 and 74 years without CHD at baseline.Outcome measureNon-fatal or fatal CHD events between 1997 and 2011. During an 11.6-year median follow-up, 2596 CHD events (1903 non-fatal and 693 fatal) occurred in the cohort. The optimal CHD model was created by adding high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol and triglycerides to the basic CHD model, evaluating using the area under the receiver operating characteristic curve (ROC) and continuous net reclassification index (NRI).ResultsThe optimal CHD models for men and women included HDL-cholesterol (NRI=0.284) and triglycerides (NRI=0.207) from the basic CHD model, respectively. The discrimination using the CHD model in the Korean cohort was high: the areas under ROC were 0.764 (95% CI 0.752 to 0.774) for men and 0.815 (95% CI 0.795 to 0.835) for women. The Framingham risk function predicted 3–6 times as many CHD events than observed. Recalibration of the Framingham function using the mean values of risk factors and mean CHD incidence rates of the KHS cohort substantially improved the performance of the Framingham functions in the KHS cohort.ConclusionsThe present study provides the first evidence that the Framingham risk function overestimates the risk of CHD in the Korean population where CHD incidence is low. The Korean CHD risk model is well-calculated alternations which can be used to predict an individual's risk of CHD and provides a useful guide to identify the groups at high risk for CHD among Koreans.

Incremental Benefit of Coronary Artery Calcium Score Above Traditional Risk Factors for All-Cause Mortality in Asymptomatic Korean Adults

“…Prior studies show that FRS tends to overestimate coronary risk in Asian populations. 21 Despite this limitation, this registry is the largest databank with regard to the use of CACS and the utility of its addition to FRS in an Asian population with a relatively long follow-up duration.…”

“…4, 21 Thus, in an effort to improve risk assessment in varying populations, it is recommended to explore alternative risk markers additional to FRS. To this end, CACS appears to be a useful adjunct to FRS when assessing cardiovascular risk, because CACS typically reflects atherosclerotic plaque burden in the coronary arteries.…”

Coronary Artery Calcification in the Asian Population: An Overview of the Results from the Korea Initiatives on Coronary Artery Calcification Registry

“…The FRS has been adapted for the prediction of cardiovascular event risk worldwide [15,16]. Although FRS is being used as a valuable tool for cardiovascular risk assessment, general extrapolation of this algorithm to various ethnicities or races may misclassify CAD risk in as much as the FRS was predominantly established based on a Caucasian population [17,18]. To this end, several previous studies have examined multiple ethnic or racial groups in an effort to test the utility or validity of the FRS.…”

“…To this end, several previous studies have examined multiple ethnic or racial groups in an effort to test the utility or validity of the FRS. Several investigators have demonstrated the overestimation of cardiovascular risk when FRS was directly applied to other ethnicities, such as in Asia including South Korea and several countries in Europe [17][18][19][20][21][22]. In a study based on a Korean population, the investigators reported that FRS overestimated CAD risk and CAD incidence was low [18].…”

Image Evaluation and Association Analysis of the Cardiovascular Disease of the Degree of Pancreatic Steatosis in Ultrasonography

“…To evaluate the degree of arteriosclerosis we performed PWV and ABI. Blood vessel elasticity is studied by aortic PWV, whereas ABI can evaluate the degree of angiostenosis or occlusion by calculating both humerus and ankle pressure [16,17]. Thus, the risk of cardiovascular diseases can be evaluated by the conditions of these vessels [18,19].…”