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An R-Based Landscape Validation of a Competing Risk Model
Published on: September 16, 2022
The ACC/AHA 2013 pooled cohort equations compared to a Korean Risk Prediction Model for atherosclerotic
Keum Ji Jung1, Yangsoo Jang2, Dong Joo Oh3
1Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.
Insights
The American College of Cardiology/American Heart Association (ACC/AHA) equations overestimate atherosclerotic cardiovascular disease (ASCVD) risk in Koreans. A new Korean Risk Prediction Model (KRPM) demonstrates superior calibration and predictive ability for ASCVD events in this population.
Area of Science:
- Cardiovascular epidemiology
- Risk prediction modeling
- Public health
Background:
- The American College of Cardiology/American Heart Association (ACC/AHA) 2013 Pooled Cohort Equations are widely used for atherosclerotic cardiovascular disease (ASCVD) risk prediction.
- The applicability of these equations to diverse ethnic populations, such as Koreans, requires evaluation.
- The Korean Heart Study (KHS) provides a valuable dataset for assessing ASCVD risk prediction models.
Purpose of the Study:
- To evaluate the performance of the ACC/AHA 2013 Pooled Cohort Equations in a Korean population.
- To develop and validate a novel Korean Risk Prediction Model (KRPM) for ASCVD events tailored to Koreans.
Main Methods:
- Analysis of the Korean Heart Study (KHS) cohort, comprising 200,010 Korean adults aged 40-79 years, free from ASCVD at baseline.
- Assessment of discrimination and calibration of the ACC/AHA Equations (White and African-American models) for predicting 10-year ASCVD risk.
- Development of the Korean Risk Prediction Model (KRPM) using Cox model coefficients and KHS cohort data.
Main Results:
- The ACC/AHA Equations showed moderate discrimination (AUROCs ranging from 0.725 to 0.739) for ASCVD risk prediction in the KHS cohort.
- Significant overestimation of ASCVD risk was observed for men (56.5%-74.1%) and underestimation for women (27.9%) using the ACC/AHA White model.
- The developed KRPM demonstrated superior calibration compared to the ACC/AHA Equations, with AUROCs of 0.741 for men and 0.745 for women.
Conclusions:
- Direct application of the ACC/AHA 2013 Pooled Cohort Equations is not recommended for ASCVD risk prediction in the Korean population.
- The Korean Risk Prediction Model (KRPM) exhibits better calibration and predictive performance for ASCVD events in Koreans.
- The KRPM is a more appropriate tool for personalized ASCVD risk assessment in the Korean population.
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.
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