Key result
New Suita score predicts 10-year ASCVD incidence with ~0.76 discrimination using traditional risk factors.
Why the study?
Applying previous risk models for stroke, CHD, and CVD at the national level was challenging due to differences in risk factors collected in Japanese governmental health check-ups.
Cohort (n=7,413)
No
New risk models based on standard Japanese health check-up items demonstrate good discrimination and calibration for predicting the 10-year incidence of stroke, CHD, and ASCVD.
May inform ASCVD risk stratification in Japanese check-ups; leaves open external validation and outcome trials before practice change.
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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Arafa et al. (2023) conducted a cohort in Atherosclerotic cardiovascular disease, stroke, and coronary heart disease (n=7,413). Traditional cardiovascular risk factors vs. Absence of risk factors was evaluated on Incidence of stroke, coronary heart disease, and atherosclerotic cardiovascular disease (model discrimination). New Suita risk models incorporating traditional cardiovascular risk factors successfully predicted the 10-year incidence of stroke, coronary heart disease, and atherosclerotic cardiovascular disease with C-statistics of 0.754, 0.782, and 0.762, respectively.
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