Field Epidemiology
Accuracy of the China-PAR and WHO risk models in predicting the ten-year risks of cardiovascular disease in the Chinese population
Chen Weiye, Liu Xiaofei, Shen Peng, Chen Qi, Sun Yexiang, Wu Jinguo, Lu Ping, Zhang Jingyi, Lin Hongbo, Tang Xun, Gao Pei
Published 2022-08-10
Cite as Chin J Epidemiol, 2022, 43(8): 1275-1281. DOI: 10.3760/cma.j.cn112338-20211206-00952
Abstract
ObjectiveTo externally validate and compare the accuracy of the China-PAR (Prediction for ASCVD Risk in China) model and the 2019 World Health Organization (WHO) cardiovascular disease risk charts for East Asian in predicting a 10-year cardiovascular disease in a general Chinese population.
MethodsParticipants aged 40-79 years without prior cardiovascular disease at baseline in the CHinese Electronic health Records Research in Yinzhou (CHERRY) were analyzed. The Kaplan-Meier analysis estimated the observed cardiovascular events (including non-fatal myocardial infarction, fatal coronary heart disease, and non-fatal or fatal stroke) rate within ten years. The expected risks were calculated using the WHO risk charts for East Asia (including the laboratory-based and non-laboratory-based models) and the China-PAR model. The expected-observed ratios were calculated to evaluate the overestimation or underestimation of the models in the cohort. Model accuracy was assessed by discrimination C-index, calibration χ2 value, and calibration plots.
ResultsDuring a median of 7.26 years of follow-up, 13 301 cardiovascular events were identified among 225 811 participants. The C-index for the China-PAR model, WHO laboratory-based model and WHO non-laboratory-based model were 0.741 (0.735-0.747), 0.747 (0.740-0.753), and 0.739 (0.733-0.746) for men, and 0.782 (0.776-0.788), 0.789 (0.783-0.795), and 0.782 (0.776-0.787) for women, respectively. The WHO laboratory-based model and non-laboratory-based model underestimated the 10-year ASCVD risk by around 15% in women and underestimated by 0.8% and 4.4% in men, respectively. The China-PAR model underestimated the risks by 19.5% and 42.3% for men and women.
ConclusionsThe China-PAR and WHO models all have pretty good discriminations for 10-year cardiovascular risk assessment in this general Chinese population. However, the accuracy should be improved in the highest-risk groups, suggesting further specific models are still needed for those with the highest risk, such as patients with diabetes or older persons.
Key words:
Cardiovascular diseases; Risk assessment; Prediction model; Cohort study
Contributor Information
Chen Weiye
Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
Liu Xiaofei
Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
Shen Peng
Yinzhou District Center for Disease Control and Prevention, Ningbo 315100, China
Chen Qi
Yinzhou District Center for Disease Control and Prevention, Ningbo 315100, China
Sun Yexiang
Yinzhou District Center for Disease Control and Prevention, Ningbo 315100, China
Wu Jinguo
Wonders Information Co.Ltd, Shanghai 201112, China
Lu Ping
Wonders Information Co.Ltd, Shanghai 201112, China
Zhang Jingyi
Wonders Information Co.Ltd, Shanghai 201112, China
Lin Hongbo
Yinzhou District Center for Disease Control and Prevention, Ningbo 315100, China
Tang Xun
Center of Real-world Evidence Evaluation, Peking University Clinical Research Institute, Beijing 100191, China
Gao Pei
Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing 100191, China
