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Validating World Health Organization cardiovascular disease risk charts and optimizing risk assessment in China

BACKGROUND: World Health Organization (WHO) released region-specific cardiovascular disease (CVD) risk prediction charts recently, but the extent to which the charts can apply to Chinese population is unknown. We aimed to validate the WHO CVD risk charts for East Asia, and evaluate their practicabil...

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Autores principales: Li, Jianxin, Liu, Fangchao, Yang, Xueli, Cao, Jie, Chen, Shufeng, Chen, Jichun, Huang, Keyong, Shen, Chong, Liu, Xiaoqing, Yu, Ling, Zhao, Yingxin, Wu, Xianping, Zhao, Liancheng, Wu, Xigui, Li, Ying, Hu, Dongsheng, Huang, Jianfeng, Lu, Xiangfeng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8315380/
https://www.ncbi.nlm.nih.gov/pubmed/34327424
http://dx.doi.org/10.1016/j.lanwpc.2021.100096
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author Li, Jianxin
Liu, Fangchao
Yang, Xueli
Cao, Jie
Chen, Shufeng
Chen, Jichun
Huang, Keyong
Shen, Chong
Liu, Xiaoqing
Yu, Ling
Zhao, Yingxin
Wu, Xianping
Zhao, Liancheng
Wu, Xigui
Li, Ying
Hu, Dongsheng
Huang, Jianfeng
Lu, Xiangfeng
author_facet Li, Jianxin
Liu, Fangchao
Yang, Xueli
Cao, Jie
Chen, Shufeng
Chen, Jichun
Huang, Keyong
Shen, Chong
Liu, Xiaoqing
Yu, Ling
Zhao, Yingxin
Wu, Xianping
Zhao, Liancheng
Wu, Xigui
Li, Ying
Hu, Dongsheng
Huang, Jianfeng
Lu, Xiangfeng
author_sort Li, Jianxin
collection PubMed
description BACKGROUND: World Health Organization (WHO) released region-specific cardiovascular disease (CVD) risk prediction charts recently, but the extent to which the charts can apply to Chinese population is unknown. We aimed to validate the WHO CVD risk charts for East Asia, and evaluate their practicability combining with China-PAR (Prediction for Atherosclerotic Cardiovascular Disease Risk in China) equations among Chinese adults. METHODS: The China-PAR cohort with 93,234 participants aged 40–80 years was followed up during 1992–2015, including 29,337 participants from three sub-cohorts with follow-up period of over 10 years. We validated the WHO CVD risk charts using the China-PAR cohort by assessment of the predicted number of events, C index, calibration χ², and calibration plots, further elaborated the concordance between the China-PAR equations and the WHO risk charts. FINDINGS: During an average follow-up of 13•64 years, 1849 incident CVD cases were identified from 29,337 participants. Both the laboratory-based and non-laboratory-based charts overestimated CVD events by 59% and 58% in men, and by 72% and 85% in women, respectively. However, 92% of participants identified as high risk by the China-PAR equations could be successfully detected by the laboratory-based charts at the cut-off point of 10%. We also observed that the non-laboratory-based charts demonstrated the poor performance for diabetic population, with high proportion of high-risk individuals (17% for men, 31% for women) would be missed. INTERPRETATION: Although the WHO CVD risk charts for East Asia apparently overestimated CVD risk among Chinese population, they could be pragmatic pre-selection tools, as potential supplement to the China-PAR equations. The widespread use of the WHO risk charts along with the China-PAR equations might facilitate the implementation of the risk-based CVD prevention in China. FUNDING: Full funding sources are listed at the end of the paper (see Acknowledgments).
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spelling pubmed-83153802021-07-28 Validating World Health Organization cardiovascular disease risk charts and optimizing risk assessment in China Li, Jianxin Liu, Fangchao Yang, Xueli Cao, Jie Chen, Shufeng Chen, Jichun Huang, Keyong Shen, Chong Liu, Xiaoqing Yu, Ling Zhao, Yingxin Wu, Xianping Zhao, Liancheng Wu, Xigui Li, Ying Hu, Dongsheng Huang, Jianfeng Lu, Xiangfeng Lancet Reg Health West Pac Research Paper BACKGROUND: World Health Organization (WHO) released region-specific cardiovascular disease (CVD) risk prediction charts recently, but the extent to which the charts can apply to Chinese population is unknown. We aimed to validate the WHO CVD risk charts for East Asia, and evaluate their practicability combining with China-PAR (Prediction for Atherosclerotic Cardiovascular Disease Risk in China) equations among Chinese adults. METHODS: The China-PAR cohort with 93,234 participants aged 40–80 years was followed up during 1992–2015, including 29,337 participants from three sub-cohorts with follow-up period of over 10 years. We validated the WHO CVD risk charts using the China-PAR cohort by assessment of the predicted number of events, C index, calibration χ², and calibration plots, further elaborated the concordance between the China-PAR equations and the WHO risk charts. FINDINGS: During an average follow-up of 13•64 years, 1849 incident CVD cases were identified from 29,337 participants. Both the laboratory-based and non-laboratory-based charts overestimated CVD events by 59% and 58% in men, and by 72% and 85% in women, respectively. However, 92% of participants identified as high risk by the China-PAR equations could be successfully detected by the laboratory-based charts at the cut-off point of 10%. We also observed that the non-laboratory-based charts demonstrated the poor performance for diabetic population, with high proportion of high-risk individuals (17% for men, 31% for women) would be missed. INTERPRETATION: Although the WHO CVD risk charts for East Asia apparently overestimated CVD risk among Chinese population, they could be pragmatic pre-selection tools, as potential supplement to the China-PAR equations. The widespread use of the WHO risk charts along with the China-PAR equations might facilitate the implementation of the risk-based CVD prevention in China. FUNDING: Full funding sources are listed at the end of the paper (see Acknowledgments). Elsevier 2021-02-05 /pmc/articles/PMC8315380/ /pubmed/34327424 http://dx.doi.org/10.1016/j.lanwpc.2021.100096 Text en © 2021 The Authors. Published by Elsevier Ltd. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Research Paper
Li, Jianxin
Liu, Fangchao
Yang, Xueli
Cao, Jie
Chen, Shufeng
Chen, Jichun
Huang, Keyong
Shen, Chong
Liu, Xiaoqing
Yu, Ling
Zhao, Yingxin
Wu, Xianping
Zhao, Liancheng
Wu, Xigui
Li, Ying
Hu, Dongsheng
Huang, Jianfeng
Lu, Xiangfeng
Validating World Health Organization cardiovascular disease risk charts and optimizing risk assessment in China
title Validating World Health Organization cardiovascular disease risk charts and optimizing risk assessment in China
title_full Validating World Health Organization cardiovascular disease risk charts and optimizing risk assessment in China
title_fullStr Validating World Health Organization cardiovascular disease risk charts and optimizing risk assessment in China
title_full_unstemmed Validating World Health Organization cardiovascular disease risk charts and optimizing risk assessment in China
title_short Validating World Health Organization cardiovascular disease risk charts and optimizing risk assessment in China
title_sort validating world health organization cardiovascular disease risk charts and optimizing risk assessment in china
topic Research Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8315380/
https://www.ncbi.nlm.nih.gov/pubmed/34327424
http://dx.doi.org/10.1016/j.lanwpc.2021.100096
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