What is the clinical evidence from this study?

Study design: Cohort. Population: Coronary heart disease (CHD) risk prediction (n=268315). Intervention: Korean CHD risk model vs. Framingham CHD Risk Score. Primary outcome: Discrimination for non-fatal or fatal CHD events (Area under the ROC curve) (AUC 0.764 (men) and 0.815 (women), 95% CI 0.752-0.774 (men); 0.795-0.835 (women)).

May 1, 2014BMJ Open196 citationsOpen Access

A coronary heart disease prediction model: the Korean Heart Study

SJSun Ha Jee YJYangsoo Jang DODong Joo Oh

Key Result

The Korean coronary heart disease risk model demonstrated high discrimination (AUC 0.764 for men, 0.815 for women), whereas the Framingham risk score overestimated CHD events by 3 to 6 times.

Study Design

Type

Cohort (n=268,315)

Multicenter

Yes

Structured PICO

Does a population-specific Korean CHD risk model improve prediction of CHD events compared to the Framingham risk score in a Korean cohort?

Population

268,315 Korean adults aged 30 to 74 years without coronary heart disease at baseline, followed for a median of 11.6 years to develop and validate a cardiovascular risk prediction model.

Exposure

Korean CHD risk model (incorporating HDL-cholesterol, LDL-cholesterol, and triglycerides)

Comparator

Framingham CHD risk score

Outcome

Non-fatal or fatal CHD events between 1997 and 2011hard clinical

Main Result

Effect estimate: AUC 0.764 (men) and 0.815 (women) (95% CI 0.752-0.774 (men); 0.795-0.835 (women))

Limitations

Possible measurement errors from one-time measurements of blood pressure and medical examinations
Non-random sample used
Self-reported smoking status and alcohol consumption may be under-reported
Validation study on mortality data has not been conducted

Abstract

OBJECTIVE: The objectives of this study were to develop a coronary heart disease (CHD) risk model among the Korean Heart Study (KHS) population and compare it with the Framingham CHD risk score. DESIGN: A prospective cohort study within a national insurance system. SETTING: 18 health promotion centres nationwide between 1996 and 2001 in Korea. PARTICIPANTS: 268 315 Koreans between the ages of 30 and 74 years without CHD at baseline. OUTCOME MEASURE: Non-fatal or fatal CHD events between 1997 and 2011. During an 11.6-year median follow-up, 2596 CHD events (1903 non-fatal and 693 fatal) occurred in the cohort. The optimal CHD model was created by adding high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol and triglycerides to the basic CHD model, evaluating using the area under the receiver operating characteristic curve (ROC) and continuous net reclassification index (NRI). RESULTS: The optimal CHD models for men and women included HDL-cholesterol (NRI=0.284) and triglycerides (NRI=0.207) from the basic CHD model, respectively. The discrimination using the CHD model in the Korean cohort was high: the areas under ROC were 0.764 (95% CI 0.752 to 0.774) for men and 0.815 (95% CI 0.795 to 0.835) for women. The Framingham risk function predicted 3-6 times as many CHD events than observed. Recalibration of the Framingham function using the mean values of risk factors and mean CHD incidence rates of the KHS cohort substantially improved the performance of the Framingham functions in the KHS cohort. CONCLUSIONS: The present study provides the first evidence that the Framingham risk function overestimates the risk of CHD in the Korean population where CHD incidence is low. The Korean CHD risk model is well-calculated alternations which can be used to predict an individual's risk of CHD and provides a useful guide to identify the groups at high risk for CHD among Koreans.

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