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Multivariate risk estimation for coronary heart disease: the Busselton Health Study
M W Knuiman1, H T Vu, H C Bartholomew
1Department of Public Health, University of Western Australia. matthew@dph.uwa.edu.au
Insights
This study developed new coronary heart disease (CHD) risk scores for Australian men and women using a multivariate approach. These scores provide better identification of individuals at high risk of CHD events.
Area of Science:
- Cardiology
- Preventive Medicine
- Epidemiology
Background:
- Coronary heart disease (CHD) is multifactorial, necessitating simultaneous assessment of all cardiovascular risk factors.
- Current methods of adding 'at risk' factors inadequately identify individuals with multiple moderately elevated risks.
- Existing CHD risk scores are limited for women and absent for Australian populations.
Purpose of the Study:
- To estimate age-specific absolute risks of CHD hospitalisation or death in an Australian cohort.
- To develop multivariate CHD risk scoring systems for both men and women using Australian data.
- To assess the generalisability and applicability of these risk scores to the Australian population in the late 1990s.
Main Methods:
- Utilised data from the 1978 Busselton Health Survey, including CHD risk factors and morbidity/mortality follow-up.
- Developed multivariate risk scoring systems incorporating age, blood pressure, cholesterol levels, smoking, diabetes, and other factors.
- Calculated age-specific absolute CHD risk estimates.
Main Results:
- Developed novel, multivariate CHD risk scoring systems tailored for Australian men and women.
- Provided age-specific absolute risk estimates for CHD hospitalisation or death.
- The study discusses the applicability of these developed risk estimation systems.
Conclusions:
- Multivariate risk scores are more effective than simple summation for identifying individuals at high risk of CHD.
- The developed scoring systems offer a valuable tool for assessing CHD risk in Australian populations.
- This research addresses a gap in CHD risk assessment tools for Australian women.
Abstract:
Coronary heart disease (CHD) is a multifactorial disease and CHD risk should be estimated by assessing all cardiovascular risk factors simultaneously. Simply adding up the number of factors with 'at risk' values fails to identify high-risk subjects with multiple risk factors at moderately elevated values. A more efficient approach is to use a quantitative multivariate risk score. A number of overseas studies have produced CHD risk scoring systems for men. There are few risk scores developed for women and no CHD risk scores have been developed from Australian data. This study used data on CHD risk factors and morbidity/mortality follow-up for the 1978 Busselton Health Survey participants to provide age-specific estimates of absolute risk of CHD hospitalisation or death, and to develop multivariate CHD risk scoring systems for men and women. The scores are based on age, blood pressure, anti-hypertensive medication, total and HDL cholesterol, smoking, diabetes, left ventricular hypertrophy and previous history of CHD. The generalisability and applicability of these risk estimation systems to Australian populations in the late 1990s is discussed.