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(Circulation. 2006;114:2217-2225.)
© 2006 American Heart Association, Inc.

Epidemiology

Estimation of 10-Year Risk of Fatal and Nonfatal Ischemic Cardiovascular Diseases in Chinese Adults

Yangfeng Wu, MD, PhD; Xiaoqing Liu, MD; Xian Li, MD; Ying Li, MD; Liancheng Zhao, MD; Zuo Chen, MD; Yihe Li, MD; Xuxu Rao, MD; Beifan Zhou, MD; Robert Detrano, MD, PhD; Kiang Liu, PhD, for the USA-PRC Collaborative Study of Cardiovascular and Cardiopulmonary Epidemiology Research Group and the China Multicenter Collaborative Study of Cardiovascular Epidemiology (China MUCA) Research Group

From the Cardiovascular Institute and Fuwai Hospital (Y.W., X. Li, Ying Li, L.Z., Z.C., B.Z.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Guangdong Provincial Cardiovascular Institute (X. Liu, Yihe Li, X.R.), Guangzhou, China; University of California (R.D.), Irvine; and Northwestern University School of Medicine (K.L.), Chicago, Ill. Dr Wu is currently at the Peking University School of Public Health, Beijing, China.

Correspondence to Dr Yangfeng Wu, MD, PhD, Professor and Chief, Department of Epidemiology, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China. E-mail yangfengwu{at}263.net

Received November 19, 2004; de novo received February 19, 2006; revision received September 13, 2006; accepted September 15, 2006.

Background— Stroke is much more prevalent than coronary heart disease in China; thus, any risk prediction model only for coronary heart disease may not be appropriate in application. Our objective is to develop a cardiovascular risk prediction model appropriate for the Chinese population.

Methods and Results— Cox proportional hazards regression was used to develop sex-specific optimal 10-year risk prediction models for ischemic cardiovascular disease (ICVD; including ischemic stroke and coronary events) from 17 years of follow-up data from the USA-PRC Collaborative Study of Cardiovascular Epidemiology cohort, in which 9903 participants were followed up every 2 years until 2000, and 371 ICVD events (266 strokes and 105 coronary heart disease events) occurred. The models showed ICVD was positively related to age, systolic blood pressure, serum total cholesterol, body mass index, current smoking status, and diabetes mellitus in both men and women. When the models were applied to the 17 329 participants in the China Multicenter Collaborative Study of Cardiovascular Epidemiology cohort, the areas under the receiver operating characteristic curve were 0.796±0.036 for men and 0.791±0.036 for women. The simplified point score model resulted in similar c statistics. Comparison of the observed with the estimated incidence of ICVD at different risk levels showed satisfactory precision. Meanwhile, application of recalibrated Framingham models significantly overestimated the coronary heart disease risk in both men (by 97%) and women (by 228%).

Conclusions— The Cox regression prediction models and simplified point score model have satisfying predictive capability for estimating the 10-year integrated cardiovascular risk in Chinese, in whom stroke is the predominant cardiovascular disease.

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