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Predicting coronary heart disease using risk factor categories for a Japanese urban population, and comparison with
Kunihiro Nishimura1, Tomonori Okamura, Makoto Watanabe
1Department of Preventive Medicine, National Cerebral and Cardiovascular Center.
Insights
The Framingham risk score overestimates coronary heart disease risk in Japanese populations. A new Suita score, including chronic kidney disease, more accurately predicts coronary heart disease risk for this demographic.
Area of Science:
- Cardiovascular epidemiology
- Biostatistics
- Public health
Background:
- The Framingham risk score (FRS) is a standard tool for predicting coronary heart disease (CHD) incidence.
- Previous studies have not evaluated the FRS efficacy in Japanese populations.
- Accurate CHD risk prediction is crucial for preventative cardiovascular care.
Purpose of the Study:
- To develop novel coronary prediction algorithms for the Japanese population, analogous to the FRS.
- To compare the predictive accuracy of new algorithms against the original FRS.
Main Methods:
- Utilized data from a large, population-based cohort study (Suita study) of 5,521 healthy Japanese individuals.
- Followed participants for an average of 11.8 years, observing 213 CHD cases.
- Employed a multiple Cox proportional hazard model with stepwise selection to construct prediction models.
Main Results:
- The newly developed Suita score demonstrated superior accuracy compared to the original and recalibrated FRS, as indicated by C-statistics.
- The Suita score, incorporating chronic kidney disease (CKD), achieved a 41.2% net reclassification improvement (NRI) over the FRS (P<0.001).
- Calibration analysis revealed that both the original and recalibrated FRS overestimated CHD risk in the Japanese cohort, while the Suita score with CKD provided more accurate predictions.
Conclusions:
- The Framingham risk score and its recalibrated version overestimate the 10-year risk of coronary heart disease in the Japanese population.
- A predictive score incorporating chronic kidney disease (CKD) as a risk factor offers more accurate coronary heart disease prediction for Japanese individuals than the original FRS, based on C-statistics and NRI.
Aim:
The Framingham risk score (FRS) is one of the standard tools used to predict the incidence of coronary heart disease (CHD). No previous study has investigated its efficacy for a Japanese population cohort. The purpose of this study was to develop new coronary prediction algorithms for the Japanese population in the manner of the FRS, and to compare them with the original FRS.
Methods:
Our coronary prediction algorithms for Japanese were based on a large population-based cohort study (Suita study). The study population comprised 5,521 healthy Japanese. They were followed-up for 11.8 years on average, and 213 cases of CHD were observed. Multiple Cox proportional hazard model by stepwise selection was used to construct the prediction model.
Results:
Our coronary prediction algorithms for Japanese patients were based on a large populationbased cohort study (the Suita study). A multiple Cox proportional hazard model by stepwise selection was used to construct the prediction model. The C-statistics showed that the new model had better accuracy than the original and recalibrated Framingham scores. The net reclassification improvement (NRI) by the Suita score with the inclusion of CKD was 41.2% (P＜0.001) compared with the original FRS. The recalibration of the FRS slightly improved the efficiency of the prediction, but it was still worse than the Suita score with the CKD model. The calibration analysis suggested that the original FRS and the recalibrated FRS overestimated the risk of CHD in the Japanese population. The Suita score with CKD more accurately predicted the risk of CHD.
Conclusion:
The FRS and recalibrated FRS overestimated the 10-year risk of CHD for the Japanese population. A predictive score including CKD as a coronary risk factor for the Japanese population was more accurate for predicting CHD than the original Framingham risk scores in terms of the C-statics and NRI.
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