Development and validation of a cardiovascular risk prediction model for Japanese: the Hisayama study

Abstract

The objective of this paper is to develop a new risk prediction model of cardiovascular disease and to validate its performance in a general population of Japanese. The Hisayama study is a population-based prospective cohort study. A total of 2634 participants aged 40 years or older were followed up for 14 years for incident cardiovascular disease (stroke and coronary heart disease (myocardial infarction, coronary revascularization and sudden cardiac death)). We used data among a random two-thirds (the derivation cohort, n¼1756) to develop a new risk prediction model that was then tested to compare observed and predicted outcomes in the remaining one-third (the validation cohort, n¼878). A multivariable cardiovascular risk prediction model was developed that incorporated age, sex, systolic blood pressure, diabetes, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and smoking. We assessed the performance of the model for predicting individual cardiovascular event among the validation cohort. The risk prediction model demonstrated good discrimination (c-statistic¼0.81; 95% confidence interval, 0.77 to 0.86) and calibration (Hosmer-Lemeshow v 2 -statistic¼6.46; P¼0.60). A simple risk score sheet based on the cardiovascular risk prediction model was also presented. We developed and validated a new cardiovascular risk prediction model in a general population of Japanese. The risk prediction model would provide a useful guide to estimate absolute risk of cardiovascular disease and to treat individual risk factors.

Predicting Coronary Heart Disease Using Risk Factor Categories for a Japanese Urban Population, and Comparison with the Framingham Risk Score: The Suita Study

“…Although recalibration with the mean value of the risk factors and baseline survival functions for the study cohort improved the discriminatory capability for various ethnic groups in the U.S., China and the CKD population 6,12,16) , the recalibration did not improve the discriminatory capability in Japanese subjects. We believe this is probably due to the low incidence of CHD in Japan compared to Western and Chinese populations 35) .…”

From casual blood pressure measurement to long-term blood pressure burden: better elucidation of the association between versatile blood pressures and cardiovascular events

“…It is of particularly importance for the Asian populations given their well-known propensity for the development of stroke. 1 Despite a plethora of evidence showing that high blood pressure is closely related to the risk of cardiovascular disease, it is very intriguing that we are still not certain which location of blood pressure (radial, brachial or central), which component of blood pressure (systolic, diastolic or pulse) and which time period of blood pressure (daytime, nighttime or clinic) are most predictive and, therefore, clinically relevant. In this issue of the journal, Sasai et al 2 assessed the predictability of another important, and equally intriguing, aspect of high blood pressure, the long-term blood pressure burden, for cardiovascular and allcause mortality in 46 484 Japanese people free of prior cardiovascular diseases followed up for 7 years.…”

Risk-prediction tools for cardiovascular disease based on Japanese cohort studies

“…8 Risk charts for CHD and stroke from the Jichi Medical School (JMS) cohort study are also available; these were based on a 10-year prospective study of about 12 000 participants living in 12 communities, but the surveyed communities were limited to rural areas. 9,10 Arima et al 11 have now developed a riskprediction tool based on one of the most famous Japanese cohorts. A total of 2634 participants in the Hisayama study were followed up for 14 years.…”

“…Although the study by Arima et al 11 was carefully designed, it has some limitations, due mainly to its small sample size. First, sexspecific risk scores should be presented as in other previously published risk charts for the Japanese population; 7-10 however, Arima et al 11 assessed men as having a higher risk for CVD than women by two pointsequivalent to the risk increase with 10 additional years of age. Second, two types of risk score sheets are needed: one for CHD and another for stroke.…”

“…A total of 2634 participants in the Hisayama study were followed up for 14 years. Arima et al 11 used data from randomly selected two-thirds of the study population to develop a new risk-prediction model that was then tested to compare observed and predicted outcomes in the remaining one-third. The model showed good performance in detecting high-risk individuals.…”