Development of new scores for atherosclerotic cardiovascular disease using specific medical examination items: the Suita Study
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Published on: September 22, 2023
Ahmed Arafa1,2, Rena Kashima1,3, Yuka Yasui1,4
1Department of Preventive Cardiology, National Cerebral and Cardiovascular Center.
Insights
New Suita risk models predict stroke, coronary heart disease (CHD), and atherosclerotic cardiovascular disease (ASCVD) using Japanese health check-up data. These models and simple scores aid in estimating 10-year cardiovascular event risk.
Area of Science:
- Cardiovascular epidemiology
- Public health
- Preventive medicine
Background:
- Previous Suita Study risk models for stroke, CHD, and CVD had limitations for national application due to differing risk factors from Japanese health check-ups.
- A need existed for updated risk models aligned with data collected during routine Japanese governmental health examinations (Tokutei-Kenshin).
Purpose of the Study:
- To develop and validate new risk models for predicting stroke, CHD, and atherosclerotic cardiovascular disease (ASCVD) in the Japanese population.
- To ensure the new models utilize risk factors consistent with those assessed in Japanese national health check-ups.
- To create simple risk scores for estimating 10-year incidence of these cardiovascular events.
Main Methods:
- Utilized data from 7,413 participants (aged 30-84) initially free of stroke and CHD, including baseline health examinations and lifestyle questionnaires.
- Employed multivariable-adjusted Cox regression to identify risk factors for stroke, CHD, and ASCVD (defined as cerebral infarction or CHD).
- Assessed model performance using C-statistics for discrimination and Hosmer-Lemeshow tests for calibration, developing 0-100 risk scores.
Main Results:
- Over 110,428 person-years, 410 stroke, 288 CHD, and 527 ASCVD events occurred.
- Key risk factors identified include age, smoking, hypertension, diabetes, lipid profiles (HDL, LDL), and urinary protein levels.
- Risk models demonstrated strong performance (C-statistics >0.750) and good calibration (p-values >0.30), with distinct 10-year incidence rates across different risk score categories.
Conclusions:
- Successfully developed new Suita risk models for stroke, CHD, and ASCVD incorporating variables from Japanese governmental health check-ups.
- Created practical risk scores to predict the 10-year likelihood of experiencing stroke, CHD, and ASCVD events.
- These updated models and scores facilitate more accurate cardiovascular risk assessment in the Japanese population using routinely collected health data.
Background:
We previously developed risk models predicting stroke, coronary heart disease (CHD), and cardiovascular disease (CVD) among Japanese people from the Suita Study. Yet, applying these models at the national level was challenging because some of the included risk factors differed from those collected in the Japanese governmental health check-ups, such as Tokutei-Kenshin. We, therefore, conducted this study to develop new risk models for stroke, CHD, and atherosclerotic CVD (ASCVD), based on data from the Suita Study. The new models used traditional cardiovascular risk factors similar to those in the Japanese governmental health check-ups.
Methods:
We included 7,413 participants, aged 30-84 years, initially free from stroke and CHD. All participants received baseline health examinations, including a questionnaire assessing their lifestyle and medical history, medical examination, and blood and urine analysis. The risk factors of stroke, CHD, and ASCVD (cerebral infarction or CHD) were determined using the multivariable-adjusted Cox regression. The models' performance was assessed using the C-statistics for discrimination and the Hosmer-Lemeshow for calibration. We also developed three simple scores (zero to 100) that could predict the 10-year incidence of stroke, CHD, and ASCVD.
Results:
Within 110,428 person-years (median follow-up = 16.6 years), 410 stroke events, 288 CHD events, and 527 ASCVD events were diagnosed. Age, smoking, hypertension, and diabetes were associated with stroke, CHD, and ASCVD risk. Men and those with decreased high-density lipoproteins or increased low-density lipoproteins showed a higher risk of CHD and ASCVD. Urinary proteins were associated with an increased risk of stroke and ASCVD. The C-statistic values of the risk models were >0.750 and the p-values of goodness-of-fit were >0.30. The 10-year incidence of stroke, CVD, and ASCVD events was 3.8%, 3.5%, and 5.7% for scores 45-54, 10.3%, 11.8%, and 19.6% for scores 65-74, and 27.7%, 23.5%, and 60.5% for scores ≥85, respectively.
Conclusions:
We developed new Suita risk models for stroke, CHD, and ASCVD using variables similar to those in the Japanese governmental health check-ups. We also developed new risk scores to predict incident stroke, CHD, and ASCVD within 10 years.
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