The ACC/AHA 2013 pooled cohort equations compared to a Korean Risk Prediction Model for atherosclerotic cardiovascular disease

Keum Ji Jung, Yangsoo Jang, Dong Joo Oh, Byung Hee Oh, Sang Hoon Lee, Seong Wook Park, Ki Bae Seung, Hong Kyu Kim, Young Duk Yun, Sung Hee Choi, Jidong Sung, Tae Yong Lee, Sung hi Kim, Sang Baek Koh, Moon Chan Kim, Hyeon Chang Kim, Heejin Kimm, Chungmo Nam, Sungha Park, Sun Ha Jee

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Abstract

Background and aims: To evaluate the performance of the American College of Cardiology/American Heart Association (ACC/AHA) 2013 Pooled Cohort Equations in the Korean Heart Study (KHS) population and to develop a Korean Risk Prediction Model (KRPM) for atherosclerotic cardiovascular disease (ASCVD) events. Methods: The KHS cohort included 200,010 Korean adults aged 40-79 years who were free from ASCVD at baseline. Discrimination, calibration, and recalibration of the ACC/AHA Equations in predicting 10-year ASCVD risk in the KHS cohort were evaluated. The KRPM was derived using Cox model coefficients, mean risk factor values, and mean incidences from the KHS cohort. Results: In the discriminatory analysis, the ACC/AHA Equations' White and African-American (AA) models moderately distinguished cases from non-cases, and were similar to the KRPM: For men, the area under the receiver operating characteristic curve (AUROCs) were 0.727 (White model), 0.725 (AA model), and 0.741 (KRPM); for women, the corresponding AUROCs were 0.738, 0.739, and 0.745. Absolute 10-year ASCVD risk for men in the KHS cohort was overestimated by 56.5% (White model) and 74.1% (AA model), while the risk for women was underestimated by 27.9% (White model) and overestimated by 29.1% (AA model). Recalibration of the ACC/AHA Equations did not affect discriminatory ability but improved calibration substantially, especially in men in the White model. Of the three ASCVD risk prediction models, the KRPM showed best calibration. Conclusions: The ACC/AHA Equations should not be directly applied for ASCVD risk prediction in a Korean population. The KRPM showed best predictive ability for ASCVD risk.

Original languageEnglish
Pages (from-to)367-375
Number of pages9
JournalAtherosclerosis
Volume242
Issue number1
DOIs
Publication statusPublished - 2015 Sep 1

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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    Jung, K. J., Jang, Y., Oh, D. J., Oh, B. H., Lee, S. H., Park, S. W., Seung, K. B., Kim, H. K., Yun, Y. D., Choi, S. H., Sung, J., Lee, T. Y., Kim, S. H., Koh, S. B., Kim, M. C., Chang Kim, H., Kimm, H., Nam, C., Park, S., & Jee, S. H. (2015). The ACC/AHA 2013 pooled cohort equations compared to a Korean Risk Prediction Model for atherosclerotic cardiovascular disease. Atherosclerosis, 242(1), 367-375. https://doi.org/10.1016/j.atherosclerosis.2015.07.033