Key result
Framingham, PCEs, and SCORE models yield acceptable discrimination but poor calibration for Asian CVD risk.
Why the study?
The validity of existing 10-year cardiovascular disease risk prediction models in the general Asian population was uncertain.
Are existing cardiovascular disease risk prediction models valid for predicting 10-year risk in the Asian general population?
Meta-Analysis (n=16)
Are existing cardiovascular disease risk prediction models valid for predicting 10-year risk in the Asian general population?
Standard CVD risk prediction models demonstrate acceptable discrimination but poor calibration in Asian populations, highlighting the need for regional recalibration before implementation.
Supports recalibrating CVD risk models for Asian populations; leaves open optimal ethnicity-specific equations and prospective validation.
We aimed to review the validity of existing prediction models for cardiovascular diseases (CVDs) in Asia. In this systematic review and meta-analysis, we included studies that validated prediction models for CVD risk in the general population in Asia. Various databases, including PubMed, Web of Science conference proceedings citation index, Scopus, Global Index Medicus of the World Health Organization (WHO), and Open Access Thesis and Dissertations (OATD), were searched up to November 2022. Additional studies were identified through reference lists and related reviews. The risk of bias was assessed using the PROBAST prediction model risk of bias assessment tool. Meta-analyses were performed using the random effects model, focusing on the C-statistic as a discrimination index and the observed-to-expected ratio (OE) as a calibration index. Out of 1315 initial records, 16 studies were included, with 21 external validations of six models in Asia. The validated models consisted of Framingham models, pooled cohort equations (PCEs), SCORE, Globorisk, and WHO models, combined with the results of the first four models. The pooled C-statistic for men ranged from 0.72 (95% CI 0.70 to 0.75; PCEs) to 0.76 (95% CI 0.74 to 0.78; Framingham general CVD). In women, it varied from 0.74 (95% CI 0.22 to 0.97; SCORE) to 0.79 (95% CI 0.74 to 0.83; Framingham general CVD). The pooled OE ratio for men ranged from 0.21 (95% CI 0.018 to 2.49; Framingham CHD) to 1.11 (95%CI 0.65 to 1.89; PCEs). In women, it varied from 0.28 (95%CI 0.33 to 2.33; Framingham CHD) to 1.81 (95% CI 0.90 to 3.64; PCEs). The Framingham, PCEs, and SCORE models exhibited acceptable discrimination but poor calibration in predicting the 10-year risk of CVDs in Asia. Recalibration and updates are necessary before implementing these models in the region.
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Nomali et al. (2023) conducted a meta-analysis in Cardiovascular diseases (n=16). CVD risk prediction models (Framingham, PCEs, SCORE, Globorisk, WHO) was evaluated on C-statistic (discrimination) and observed-to-expected ratio (calibration) (C-statistic 0.72-0.76 (men) and 0.74-0.79 (women)). The Framingham, PCEs, and SCORE models exhibited acceptable discrimination (pooled C-statistic 0.72-0.79) but poor calibration in predicting the 10-year risk of cardiovascular diseases in Asia.
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