American Heart Journal

2019

DOI: 10.1016/j.ahj.2019.01.009

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Performance of atherosclerotic cardiovascular risk prediction models in a rural Northern Chinese population: Results from the Fangshan Cohort Study

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Cited by 21 publications

(23 citation statements)

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“…The PAR, derived from the general Chinese population, had moderate discrimination and was well calibrated in men but substantially underestimated the 5-year ASCVD risk in women in this study. However, a recently published study conducted in a rural northern Chinese population indicated that the PAR fairly predicted the 5-year ASCVD risk in men but overestimated it by 29.4% in women [5].…”

Section: Discussionmentioning

confidence: 91%

“…The recently released Guideline on the Assessment and Management of Cardiovascular Risk in China [3] recommended calculating ASCVD risks to identify those who at high risk of ASCVD using the newly developed Prediction for ASCVD Risk in China (PAR) risk equation [4], which were generated in general Chinese population. After the development of the PAR, it has been undergone an external validation in a rural northern Chinese population, however, the performance of the PAR in predicting 5-year ASCVD risk was just moderate [5].…”

Section: Introductionmentioning

confidence: 99%

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External validation of three atherosclerotic cardiovascular disease risk equations in rural areas of Xinjiang, China

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BMC Public Health

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Background To externally validate the Prediction for ASCVD Risk in China (PAR) risk equation for predicting the 5-year atherosclerotic cardiovascular disease (ASCVD) risk in the Uyghur and Kazakh populations from rural areas in northwestern China and compare its performance with those of the pooled cohort equations (PCE) and Framingham risk score (FRS). Methods The final analysis included 3347 subjects aged 40–74 years without CVD at baseline. The 5-year ASCVD risk was calculated using the PAR, PCE, and FRS. Discrimination, calibration, and clinical usefulness of the three equations in predicting the 5-year ASCVD risk were assessed before and after recalibration. Results Of 3347 included subjects, 1839 were female. We observed 286 ASCVD events in within 5-year follow-up. All three risk equations had moderate discrimination in both men and women. C-indices of PAR, PCE, and FRS were 0.727 (95% CI, 0.725–0.729), 0.727 (95% CI, 0.725–0.729), and 0.740 (95% CI, 0.738–0.742), respectively, in men; the corresponding C-indices were 0.738 (95% CI, 0.737–0.739), 0.731 (95% CI, 0.730–0.732), and 0.761 (95% CI, 0.760–0.762), respectively, in women. PCE, PAR and FRS substantially underestimated the 5-year ASCVD risk in women by 70, 23 and 51%, respectively. However, PAR and FRS fairly predicted the risk in men and PAR was well calibrated. The calibrations of the three risk equations could be changed by recalibration. The decision curve analyses demonstrated that at the threshold risk of 5%, PCE was the most clinically useful in both men and women after recalibration. Conclusions All three risk equations underestimated the 5-year ASCVD risk in women, while PAR and FRS fairly predicted that in men. However, the results of predictive performances for three risk equations are inconsistent, more accurate risk equations are required in the primary prevention of ASCVD aiming to this Uyghur and Kazakh populations.

“…The PAR, derived from the general Chinese population, had moderate discrimination and was well calibrated in men but substantially underestimated the 5-year ASCVD risk in women in this study. However, a recently published study conducted in a rural northern Chinese population indicated that the PAR fairly predicted the 5-year ASCVD risk in men but overestimated it by 29.4% in women [5].…”

Section: Discussionmentioning

confidence: 91%

“…The recently released Guideline on the Assessment and Management of Cardiovascular Risk in China [3] recommended calculating ASCVD risks to identify those who at high risk of ASCVD using the newly developed Prediction for ASCVD Risk in China (PAR) risk equation [4], which were generated in general Chinese population. After the development of the PAR, it has been undergone an external validation in a rural northern Chinese population, however, the performance of the PAR in predicting 5-year ASCVD risk was just moderate [5].…”

Section: Introductionmentioning

confidence: 99%

External validation of three atherosclerotic cardiovascular disease risk equations in rural areas of Xinjiang, China

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et al. 2020

BMC Public Health

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Background To externally validate the Prediction for ASCVD Risk in China (PAR) risk equation for predicting the 5-year atherosclerotic cardiovascular disease (ASCVD) risk in the Uyghur and Kazakh populations from rural areas in northwestern China and compare its performance with those of the pooled cohort equations (PCE) and Framingham risk score (FRS). Methods The final analysis included 3347 subjects aged 40–74 years without CVD at baseline. The 5-year ASCVD risk was calculated using the PAR, PCE, and FRS. Discrimination, calibration, and clinical usefulness of the three equations in predicting the 5-year ASCVD risk were assessed before and after recalibration. Results Of 3347 included subjects, 1839 were female. We observed 286 ASCVD events in within 5-year follow-up. All three risk equations had moderate discrimination in both men and women. C-indices of PAR, PCE, and FRS were 0.727 (95% CI, 0.725–0.729), 0.727 (95% CI, 0.725–0.729), and 0.740 (95% CI, 0.738–0.742), respectively, in men; the corresponding C-indices were 0.738 (95% CI, 0.737–0.739), 0.731 (95% CI, 0.730–0.732), and 0.761 (95% CI, 0.760–0.762), respectively, in women. PCE, PAR and FRS substantially underestimated the 5-year ASCVD risk in women by 70, 23 and 51%, respectively. However, PAR and FRS fairly predicted the risk in men and PAR was well calibrated. The calibrations of the three risk equations could be changed by recalibration. The decision curve analyses demonstrated that at the threshold risk of 5%, PCE was the most clinically useful in both men and women after recalibration. Conclusions All three risk equations underestimated the 5-year ASCVD risk in women, while PAR and FRS fairly predicted that in men. However, the results of predictive performances for three risk equations are inconsistent, more accurate risk equations are required in the primary prevention of ASCVD aiming to this Uyghur and Kazakh populations.

“…Since the CHINA-PAR equations were developed in 2016, the validations in real practice mostly focused on the northern population [5,6]. To date, an approximately 6-fold difference in the total burden of CVD persists among provinces [1]; therefore, geographical strategies are needed to identify ASCVD throughout China in specific provinces.…”

Section: Discussionmentioning

confidence: 99%

“…However, studies have shown controversial results with the CHINA-PAR model. It outperformed PCE in ASCVD risk prediction in a rural northern Chinese population [5] but underestimated the risk in Mongolians [6]. Thus, further validation of ASCVD risk predictions in other Chinese populations needs to be performed.…”

Section: Introductionmentioning

confidence: 99%

Chinese ASCVD risk equations rather than pooled cohort equations are better to identify macro- and microcirculation abnormalities

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BMC Cardiovasc Disord

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Background: We hypothesized that discriminating the early subclinical organ damage would serve as a great opportunity for prevention against atherosclerotic cardiovascular disease (ASCVD). Brachial-ankle pulse wave velocity (baPWV), low retinal vascular fractal dimension, and albuminuria are surrogates of subclinical vascular changes. Methods: The aim of this study was to use Pooled Cohort Equations (PCE) and ASCVD risk equations derived from "Prediction for ASCVD Risk in China project (CHINA-PAR)" to observe the prevalence of macro-and microcirculation abnormalities. A total of 2166 subjects were involved. Characteristics were investigated using questionnaire and physical examinations. We calculated the urine albumin to creatinine ratio (UACR). The baPWV was measured using a fully automatic arteriosclerosis detector. The retinal vascular fractal dimension was measured by a semiautomated computer-based program. The 10-year ASCVD risk was estimated using the PCE and CHINA-PAR model. Results: The cutoff values for the elevated baPWV were 2.82 and 2.92% in the PCE model and CHINA-PAR model, respectively, with nearly 85% sensitivity and an average specificity of 74%. For low retinal fractal dimension, at the cutoff point of 3.8%, we acquired an acceptable sensitivity of 66.27-68.24% and specificity of 62.57-67.45%. All the C-statistics presented a significant improvement from the PCE model to the CHINA-PAR model (P < 0.05). For all categories-net reclassification improvement (NRI) values were significant and clearly varied (0.329, 0.183, and 0.104, respectively) depending on the cutoff set at 3%. Conclusion: Our study demonstrated that the CHINA-PAR equations rather than PCE could provide better identification of macro-and microcirculation abnormalities. A lower cutoff point for the subclinical vascular changes may be selected in a population from southeast China.

“…The R-FSRS was developed to assess the risk of stroke in individuals aged 55-84 years with no history of stroke (8). The China-PAR was mainly developed based on Chinese individuals aged 35-74 years to predict the 10-year risk of stroke (12). In order to make the samples as comparable as possible, we excluded participants aged 85 years or older.…”

Section: Study Populationmentioning

confidence: 99%

Validation of 10-Year Stroke Prediction Scores in a Community-Based Cohort of Chinese Older Adults

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Front. Neurol.

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A stroke prediction model based on the Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR) project was developed. We compared its predictive ability with the revised Framingham Stroke Risk Score (R-FSRS) for 5-year stroke incidence in a community cohort of Chinese adults, namely the Beijing Longitudinal Study of Aging (BLSA). Calibration, discrimination, and recalibration were used to compare the predictive ability between the two prediction models. Category-less net reclassification improvement (NRI) and integrated discrimination improvement (IDI) values were also assessed. During a mean follow-up duration of 5.1 years, 106 incidents of fatal or non-fatal strokes occurred among 1,203 participants aged 55-84 years. The R-FSRS applied to our cohort underestimated the 5-year risk for stroke in men and women. China-PAR performed better than the R-FSRS in terms of calibration (men, R-FSRS: χ 2-value 144.2 [P < 0.001], China-PAR: 10.4 [P = 0.238]; women, R-FSRS: 280.1 [P < 0.001], China-PAR: 12.5 [P = 0.129]). In terms of discrimination, R-FSRS and China-PAR models performed modestly in our cohort (C-statistic 0.603 [95% CI: 0.560-0.644] for men using China-PAR and 0.568 [95% CI: 0.524-0.610] using the R-FSRS; the corresponding numbers for women were 0.602 [95% CI: 0.564-0.639] and 0.575 [95% CI: 0.537-0.613). The recalibrated China-PAR model significantly improved the discrimination in C statistics and produced higher category-less NRI and IDI for stroke incidence than the R-FSRS. Although China-PAR fairly estimated stroke risk in our cohort, it did not sufficiently identify adults at high risk of stroke. Caution would be exercised by practitioners in applying the original China-PAR to Chinese older adults. Further studies are needed to develop an adequate prediction model based on the recalibrated China-PAR or to find new risk markers which could upgrade this model.

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