A novel risk score to predict cardiovascular disease risk in national populations (Globorisk)

A pooled analysis of prospective cohorts and health examination surveys

Kaveh Hajifathalian, Peter Ueda, Yuan Lu, Mark Woodward, Alireza Ahmadvand, Carlos A Aguilar-Salinas, Fereidoun Azizi, Renata Cifkova, Mariachiara Di Cesare, Louise Eriksen, Farshad Farzadfar, Nayu Ikeda, Davood Khalili, Young-Ho Khang, Vera Lanska, Luz León-Muñoz, Dianna Magliano, Kelias P. Msyamboza, Kyungwon Oh, Fernando Rodríguez-Artalejo & 8 others Rosalba Rojas-Martinez, Jonathan E. Shaw, Gretchen A. Stevens, Janne Tolstrup, Bin Zhou, Joshua A. Salomon, Majid Ezzati, Goodarz Danaei

Research output: Contribution to journalArticleResearchpeer-review

77 Citations (Scopus)

Abstract

Background: Treatment of cardiovascular risk factors based on disease risk depends on valid risk prediction equations. We aimed to develop, and apply in example countries, a risk prediction equation for cardiovascular disease (consisting here of coronary heart disease and stroke) that can be recalibrated and updated for application in different countries with routinely available information. Methods: We used data from eight prospective cohort studies to estimate coefficients of the risk equation with proportional hazard regressions. The risk prediction equation included smoking, blood pressure, diabetes, and total cholesterol, and allowed the effects of sex and age on cardiovascular disease to vary between cohorts or countries. We developed risk equations for fatal cardiovascular disease and for fatal plus non-fatal cardiovascular disease. We validated the risk equations internally and also using data from three cohorts that were not used to create the equations. We then used the risk prediction equation and data from recent (2006 or later) national health surveys to estimate the proportion of the population at different levels of cardiovascular disease risk in 11 countries from different world regions (China, Czech Republic, Denmark, England, Iran, Japan, Malawi, Mexico, South Korea, Spain, and USA). Findings: The risk score discriminated well in internal and external validations, with C statistics generally 70% or more. At any age and risk factor level, the estimated 10 year fatal cardiovascular disease risk varied substantially between countries. The prevalence of people at high risk of fatal cardiovascular disease was lowest in South Korea, Spain, and Denmark, where only 5-10% of men and women had more than a 10% risk, and 62-77% of men and 79-82% of women had less than a 3% risk. Conversely, the proportion of people at high risk of fatal cardiovascular disease was largest in China and Mexico. In China, 33% of men and 28% of women had a 10-year risk of fatal cardiovascular disease of 10% or more, whereas in Mexico, the prevalence of this high risk was 16% for men and 11% for women. The prevalence of less than a 3% risk was 37% for men and 42% for women in China, and 55% for men and 69% for women in Mexico. Interpretation: We developed a cardiovascular disease risk equation that can be recalibrated for application in different countries with routinely available information. The estimated percentage of people at high risk of fatal cardiovascular disease was higher in low-income and middle-income countries than in high-income countries. Funding: US National Institutes of Health, UK Medical Research Council, Wellcome Trust.

Original languageEnglish
Pages (from-to)339-355
Number of pages17
JournalThe Lancet Diabetes and Endocrinology
Volume3
Issue number5
DOIs
Publication statusPublished - May 2015
Externally publishedYes

Cite this

Hajifathalian, Kaveh ; Ueda, Peter ; Lu, Yuan ; Woodward, Mark ; Ahmadvand, Alireza ; Aguilar-Salinas, Carlos A ; Azizi, Fereidoun ; Cifkova, Renata ; Di Cesare, Mariachiara ; Eriksen, Louise ; Farzadfar, Farshad ; Ikeda, Nayu ; Khalili, Davood ; Khang, Young-Ho ; Lanska, Vera ; León-Muñoz, Luz ; Magliano, Dianna ; Msyamboza, Kelias P. ; Oh, Kyungwon ; Rodríguez-Artalejo, Fernando ; Rojas-Martinez, Rosalba ; Shaw, Jonathan E. ; Stevens, Gretchen A. ; Tolstrup, Janne ; Zhou, Bin ; Salomon, Joshua A. ; Ezzati, Majid ; Danaei, Goodarz. / A novel risk score to predict cardiovascular disease risk in national populations (Globorisk) : A pooled analysis of prospective cohorts and health examination surveys. In: The Lancet Diabetes and Endocrinology. 2015 ; Vol. 3, No. 5. pp. 339-355.
@article{d9ea40a6f8f246d7bf8880c40fe1a8df,
title = "A novel risk score to predict cardiovascular disease risk in national populations (Globorisk): A pooled analysis of prospective cohorts and health examination surveys",
abstract = "Background: Treatment of cardiovascular risk factors based on disease risk depends on valid risk prediction equations. We aimed to develop, and apply in example countries, a risk prediction equation for cardiovascular disease (consisting here of coronary heart disease and stroke) that can be recalibrated and updated for application in different countries with routinely available information. Methods: We used data from eight prospective cohort studies to estimate coefficients of the risk equation with proportional hazard regressions. The risk prediction equation included smoking, blood pressure, diabetes, and total cholesterol, and allowed the effects of sex and age on cardiovascular disease to vary between cohorts or countries. We developed risk equations for fatal cardiovascular disease and for fatal plus non-fatal cardiovascular disease. We validated the risk equations internally and also using data from three cohorts that were not used to create the equations. We then used the risk prediction equation and data from recent (2006 or later) national health surveys to estimate the proportion of the population at different levels of cardiovascular disease risk in 11 countries from different world regions (China, Czech Republic, Denmark, England, Iran, Japan, Malawi, Mexico, South Korea, Spain, and USA). Findings: The risk score discriminated well in internal and external validations, with C statistics generally 70{\%} or more. At any age and risk factor level, the estimated 10 year fatal cardiovascular disease risk varied substantially between countries. The prevalence of people at high risk of fatal cardiovascular disease was lowest in South Korea, Spain, and Denmark, where only 5-10{\%} of men and women had more than a 10{\%} risk, and 62-77{\%} of men and 79-82{\%} of women had less than a 3{\%} risk. Conversely, the proportion of people at high risk of fatal cardiovascular disease was largest in China and Mexico. In China, 33{\%} of men and 28{\%} of women had a 10-year risk of fatal cardiovascular disease of 10{\%} or more, whereas in Mexico, the prevalence of this high risk was 16{\%} for men and 11{\%} for women. The prevalence of less than a 3{\%} risk was 37{\%} for men and 42{\%} for women in China, and 55{\%} for men and 69{\%} for women in Mexico. Interpretation: We developed a cardiovascular disease risk equation that can be recalibrated for application in different countries with routinely available information. The estimated percentage of people at high risk of fatal cardiovascular disease was higher in low-income and middle-income countries than in high-income countries. Funding: US National Institutes of Health, UK Medical Research Council, Wellcome Trust.",
author = "Kaveh Hajifathalian and Peter Ueda and Yuan Lu and Mark Woodward and Alireza Ahmadvand and Aguilar-Salinas, {Carlos A} and Fereidoun Azizi and Renata Cifkova and {Di Cesare}, Mariachiara and Louise Eriksen and Farshad Farzadfar and Nayu Ikeda and Davood Khalili and Young-Ho Khang and Vera Lanska and Luz Le{\'o}n-Mu{\~n}oz and Dianna Magliano and Msyamboza, {Kelias P.} and Kyungwon Oh and Fernando Rodr{\'i}guez-Artalejo and Rosalba Rojas-Martinez and Shaw, {Jonathan E.} and Stevens, {Gretchen A.} and Janne Tolstrup and Bin Zhou and Salomon, {Joshua A.} and Majid Ezzati and Goodarz Danaei",
year = "2015",
month = "5",
doi = "10.1016/S2213-8587(15)00081-9",
language = "English",
volume = "3",
pages = "339--355",
journal = "The Lancet Diabetes and Endocrinology",
issn = "2213-8587",
publisher = "Elsevier",
number = "5",

}

Hajifathalian, K, Ueda, P, Lu, Y, Woodward, M, Ahmadvand, A, Aguilar-Salinas, CA, Azizi, F, Cifkova, R, Di Cesare, M, Eriksen, L, Farzadfar, F, Ikeda, N, Khalili, D, Khang, Y-H, Lanska, V, León-Muñoz, L, Magliano, D, Msyamboza, KP, Oh, K, Rodríguez-Artalejo, F, Rojas-Martinez, R, Shaw, JE, Stevens, GA, Tolstrup, J, Zhou, B, Salomon, JA, Ezzati, M & Danaei, G 2015, 'A novel risk score to predict cardiovascular disease risk in national populations (Globorisk): A pooled analysis of prospective cohorts and health examination surveys', The Lancet Diabetes and Endocrinology, vol. 3, no. 5, pp. 339-355. https://doi.org/10.1016/S2213-8587(15)00081-9

A novel risk score to predict cardiovascular disease risk in national populations (Globorisk) : A pooled analysis of prospective cohorts and health examination surveys. / Hajifathalian, Kaveh; Ueda, Peter; Lu, Yuan; Woodward, Mark; Ahmadvand, Alireza; Aguilar-Salinas, Carlos A; Azizi, Fereidoun; Cifkova, Renata; Di Cesare, Mariachiara; Eriksen, Louise; Farzadfar, Farshad; Ikeda, Nayu; Khalili, Davood; Khang, Young-Ho; Lanska, Vera; León-Muñoz, Luz; Magliano, Dianna; Msyamboza, Kelias P.; Oh, Kyungwon; Rodríguez-Artalejo, Fernando; Rojas-Martinez, Rosalba; Shaw, Jonathan E.; Stevens, Gretchen A.; Tolstrup, Janne; Zhou, Bin; Salomon, Joshua A.; Ezzati, Majid; Danaei, Goodarz.

In: The Lancet Diabetes and Endocrinology, Vol. 3, No. 5, 05.2015, p. 339-355.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - A novel risk score to predict cardiovascular disease risk in national populations (Globorisk)

T2 - A pooled analysis of prospective cohorts and health examination surveys

AU - Hajifathalian, Kaveh

AU - Ueda, Peter

AU - Lu, Yuan

AU - Woodward, Mark

AU - Ahmadvand, Alireza

AU - Aguilar-Salinas, Carlos A

AU - Azizi, Fereidoun

AU - Cifkova, Renata

AU - Di Cesare, Mariachiara

AU - Eriksen, Louise

AU - Farzadfar, Farshad

AU - Ikeda, Nayu

AU - Khalili, Davood

AU - Khang, Young-Ho

AU - Lanska, Vera

AU - León-Muñoz, Luz

AU - Magliano, Dianna

AU - Msyamboza, Kelias P.

AU - Oh, Kyungwon

AU - Rodríguez-Artalejo, Fernando

AU - Rojas-Martinez, Rosalba

AU - Shaw, Jonathan E.

AU - Stevens, Gretchen A.

AU - Tolstrup, Janne

AU - Zhou, Bin

AU - Salomon, Joshua A.

AU - Ezzati, Majid

AU - Danaei, Goodarz

PY - 2015/5

Y1 - 2015/5

N2 - Background: Treatment of cardiovascular risk factors based on disease risk depends on valid risk prediction equations. We aimed to develop, and apply in example countries, a risk prediction equation for cardiovascular disease (consisting here of coronary heart disease and stroke) that can be recalibrated and updated for application in different countries with routinely available information. Methods: We used data from eight prospective cohort studies to estimate coefficients of the risk equation with proportional hazard regressions. The risk prediction equation included smoking, blood pressure, diabetes, and total cholesterol, and allowed the effects of sex and age on cardiovascular disease to vary between cohorts or countries. We developed risk equations for fatal cardiovascular disease and for fatal plus non-fatal cardiovascular disease. We validated the risk equations internally and also using data from three cohorts that were not used to create the equations. We then used the risk prediction equation and data from recent (2006 or later) national health surveys to estimate the proportion of the population at different levels of cardiovascular disease risk in 11 countries from different world regions (China, Czech Republic, Denmark, England, Iran, Japan, Malawi, Mexico, South Korea, Spain, and USA). Findings: The risk score discriminated well in internal and external validations, with C statistics generally 70% or more. At any age and risk factor level, the estimated 10 year fatal cardiovascular disease risk varied substantially between countries. The prevalence of people at high risk of fatal cardiovascular disease was lowest in South Korea, Spain, and Denmark, where only 5-10% of men and women had more than a 10% risk, and 62-77% of men and 79-82% of women had less than a 3% risk. Conversely, the proportion of people at high risk of fatal cardiovascular disease was largest in China and Mexico. In China, 33% of men and 28% of women had a 10-year risk of fatal cardiovascular disease of 10% or more, whereas in Mexico, the prevalence of this high risk was 16% for men and 11% for women. The prevalence of less than a 3% risk was 37% for men and 42% for women in China, and 55% for men and 69% for women in Mexico. Interpretation: We developed a cardiovascular disease risk equation that can be recalibrated for application in different countries with routinely available information. The estimated percentage of people at high risk of fatal cardiovascular disease was higher in low-income and middle-income countries than in high-income countries. Funding: US National Institutes of Health, UK Medical Research Council, Wellcome Trust.

AB - Background: Treatment of cardiovascular risk factors based on disease risk depends on valid risk prediction equations. We aimed to develop, and apply in example countries, a risk prediction equation for cardiovascular disease (consisting here of coronary heart disease and stroke) that can be recalibrated and updated for application in different countries with routinely available information. Methods: We used data from eight prospective cohort studies to estimate coefficients of the risk equation with proportional hazard regressions. The risk prediction equation included smoking, blood pressure, diabetes, and total cholesterol, and allowed the effects of sex and age on cardiovascular disease to vary between cohorts or countries. We developed risk equations for fatal cardiovascular disease and for fatal plus non-fatal cardiovascular disease. We validated the risk equations internally and also using data from three cohorts that were not used to create the equations. We then used the risk prediction equation and data from recent (2006 or later) national health surveys to estimate the proportion of the population at different levels of cardiovascular disease risk in 11 countries from different world regions (China, Czech Republic, Denmark, England, Iran, Japan, Malawi, Mexico, South Korea, Spain, and USA). Findings: The risk score discriminated well in internal and external validations, with C statistics generally 70% or more. At any age and risk factor level, the estimated 10 year fatal cardiovascular disease risk varied substantially between countries. The prevalence of people at high risk of fatal cardiovascular disease was lowest in South Korea, Spain, and Denmark, where only 5-10% of men and women had more than a 10% risk, and 62-77% of men and 79-82% of women had less than a 3% risk. Conversely, the proportion of people at high risk of fatal cardiovascular disease was largest in China and Mexico. In China, 33% of men and 28% of women had a 10-year risk of fatal cardiovascular disease of 10% or more, whereas in Mexico, the prevalence of this high risk was 16% for men and 11% for women. The prevalence of less than a 3% risk was 37% for men and 42% for women in China, and 55% for men and 69% for women in Mexico. Interpretation: We developed a cardiovascular disease risk equation that can be recalibrated for application in different countries with routinely available information. The estimated percentage of people at high risk of fatal cardiovascular disease was higher in low-income and middle-income countries than in high-income countries. Funding: US National Institutes of Health, UK Medical Research Council, Wellcome Trust.

UR - http://www.scopus.com/inward/record.url?scp=84928706403&partnerID=8YFLogxK

U2 - 10.1016/S2213-8587(15)00081-9

DO - 10.1016/S2213-8587(15)00081-9

M3 - Article

VL - 3

SP - 339

EP - 355

JO - The Lancet Diabetes and Endocrinology

JF - The Lancet Diabetes and Endocrinology

SN - 2213-8587

IS - 5

ER -