Validation of the pooled cohort risk score in an Asian population – a retrospective cohort study

BMC Cardiovascular Disorders

Siew Mooi Ching²  Hooi Min Lim¹  Yook Chin Chia³ 

[1] Department of Primary Care Medicine, University of Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia;Department of Gerontology, Universiti Putra Malaysia, 43400 Serdang, Malaysia;Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, 6845 Perth, WA, Australia

关键词: Malaysia;    Retrospective cohort;    Primary care;    Cardiovascular events;    Framingham risk score;    Asian population;    Validation;    Atherosclerotic cardiovascular disease;    Pooled cohort risk score;   

Others  :  1088687
DOI  :  10.1186/1471-2261-14-163

 received in 2014-07-28, accepted in 2014-11-12,  发布年份 2014

【 摘 要 】

Background

The Pooled Cohort Risk Equation was introduced by the American College of Cardiology (ACC) and American Heart Association (AHA) 2013 in their Blood Cholesterol Guideline to estimate the 10-year atherosclerotic cardiovascular disease (ASCVD) risk. However, absence of Asian ethnicity in the contemporary cohorts and limited studies to examine the use of the risk score limit the applicability of the equation in an Asian population. This study examines the validity of the pooled cohort risk score in a primary care setting and compares the cardiovascular risk using both the pooled cohort risk score and the Framingham General Cardiovascular Disease (CVD) risk score.

Methods

This is a 10-year retrospective cohort study of randomly selected patients aged 40–79 years. Baseline demographic data, co-morbidities and cardiovascular (CV) risk parameters were captured from patient records in 1998. Pooled cohort risk score and Framingham General CVD risk score for each patient were computed. All ASCVD events (nonfatal myocardial infarction, coronary heart disease (CHD) death, fatal and nonfatal stroke) occurring from 1998–2007 were recorded.

Results

A total of 922 patients were studied. In 1998, mean age was 57.5 ± 8.8 years with 66.7% female. There were 47% diabetic patients and 59.9% patients receiving anti-hypertensive treatment. More than 98% of patients with pooled cohort risk score ≥7.5% had FRS >10%. A total of 45 CVD events occurred, 22 (7.2%) in males and 23 (3.7%) in females. The median pooled cohort risk score for the population was 10.1 (IQR 4.7-20.6) while the actual ASCVD events that occurred was 4.9% (45/922). Our study showed moderate discrimination with AUC of 0.63. There was good calibration with Hosmer-Lemeshow test χ2 = 12.6, P = 0.12.

Conclusions

The pooled cohort risk score appears to overestimate CV risk but this apparent over-prediction could be a result of treatment. In the absence of a validated score in an untreated population, the pooled cohort risk score appears to be appropriate for use in a primary care setting.

【 授权许可】

   
2014 Chia et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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