ABSTRACT
Objective:
To assess the predictive performance of the
risk of
cardiovascular diseases (CVD) derived from the
China Kadoorie Biobank (CKB-CVD) model, prediction for atherosclerotic
cardiovascular disease (ASCVD)
risk in
China (
China-PAR) model, and the
risk of fatal and nonfatal ischemic
cardiovascular diseases derived from the USA-People′s
Republic of China Collaborative Study (USA-PRC) model in
Chinese Multi-provincial
Cohort Study (CMCS).
Methods:
In this prospective
cohort study, a total of 21 948 individuals
aged ≥35 years without CVD were selected from 8 provinces and cities in
China during the CMCS
survey from 1992 to 2005 for 10-year follow-up. The occurrence of CVD or ASCVD events during the follow-up period was used as the
gold standard. The CKB-CVD and
China-PAR models were used to calculate the predicted
risk of CVD events, while the USA-PRC model was used to calculate the predicted
risk of ASCVD events. The discrimination of the models was evaluated using the C-
statistic, and the
calibration was assessed using the Hosmer-Lemeshow χ2 test and decile plot.
Results:
During the 10-year follow-up, a total of 955 (4.4%) CVD events, including 791 (3.6%) ASCVD events, were recorded among the study participants. The C-index for the CKB-CVD,
China-PAR, and USA-PRC models were 0.775 (95% CI 0.757-0.793), 0.781 (95% CI 0.763-0.798), and 0.769 (95% CI 0.750-0.789) for
men, and 0.762 (95% CI 0.737-0.788), 0.769 (95% CI 0.745-0.794), and 0.767 (95% CI 0.741-0.794) for
women, respectively.
China-PAR model showed good
calibration for
men ( χ2=2.20), however, both CKB-CVD and USA-PRC models demonstrated poor
calibration in both
men and
women ( χ2>20). The results indicated that the CKB-CVD model overestimated the
risk of CVD events in both
males and
females, while the
China-PAR model underestimated the
risk in
females. Furthermore, the USA-PRC model underestimated the
risk of ASCVD in both
males and
females in most decile groups, but overestimated the
risk in the highest decile group.
Conclusion:
The CKB-CVD,
China-PAR, and USA-PRC
risk assessment models show some degree of deviation from the actual
risk of events in the CMCS cohort, but all exhibit good discrimination.
