Key result
K-CVD equation provides optimal baseline calibration for ASCVD risk compared to PCE and China-PAR.
Why the study?
Precise 10-year ASCVD risk prediction matters for Chinese primary prevention, yet domestic risk equations had not been validated in 9-year real-world cohorts and the Korean K-CVD model had never been validated locally.
Does the Korean K-CVD risk equation improve 9-year ASCVD risk prediction calibration and clinical utility compared to the US PCE and Chinese China-PAR equations in middle-aged and older ASCVD-free Chinese adults?
Cohort (n=9,532)
Yes
Does the Korean K-CVD risk equation improve 9-year ASCVD risk prediction calibration and clinical utility compared to the US PCE and Chinese China-PAR equations in middle-aged and older ASCVD-free Chinese adults?
Absolute Event Rate: 1.16% vs 1.2%
p-value: p=>0.05
In a 9-year real-world cohort of 9,532 Chinese adults, the Korean K-CVD equation provided the best native risk calibration compared to US PCE and China-PAR, though all three equations require formal recalibration and lower decision thresholds (1–2%) to achieve positive net clinical benefit in low-risk Chinese primary care.
K-CVD calibration was superior in this Chinese cohort; extends East Asian equations but leaves open clinical utility pending recalibration and validation.
Background: Precise 10-year atherosclerotic cardiovascular disease (ASCVD) risk prediction matters for Chinese primary prevention, while domestic risk equations have not been validated in 9-year real-world cohorts, and the Korean K-CVD model has never been validated locally. Methods: This study enrolled 9,532 ASCVD-free Chinese adults aged 45–79 years from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2020) with a 9-year follow-up (114 ASCVD events, incidence 1.20%). Three risk tools (pooled cohort equation (PCE)-US, China-PAR, and K-CVD-Korea) were compared regarding discrimination (area under the receiver operating characteristic (ROC) curve (AUC)), calibration, and clinical utility via decision curve analysis (DCA); MICE was adopted to impute missing systolic blood pressure data. Results: K-CVD presented optimal calibration (predicted/observed ratio = 0.97). PCE overestimated risk by 17%, and China-PAR underestimated risk by 10%. The three models had comparable AUCs (0.775–0.777, P > 0.05). Post logit recalibration yielded identical Brier score (0.0116) for all models. DCA showed negative net benefit at thresholds ≥ 5%; PCE and K-CVD gained slight superiority over China-PAR at 1–2% thresholds matching the low actual event rate. Conclusions: K-CVD has the best native calibration in this Chinese cohort. All three equations need formal recalibration for clinical use, and low cut-offs (1–2%) are more suitable for low-risk Chinese adults instead of Western standard thresholds.
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Zhang et al. (2026) conducted a cohort in Primary prevention of atherosclerotic cardiovascular disease (ASCVD) (n=9,532). K-CVD risk equation vs. Pooled Cohort Equations (PCE) and China-PAR risk equation was evaluated on Composite first-incident ASCVD outcome (non-fatal MI, non-fatal stroke, and ASCVD-related death) calibration and discrimination (p=>0.05). The Korean K-CVD risk equation demonstrated optimal baseline calibration (predicted/observed ratio 0.97) compared to PCE (1.17) and China-PAR (0.90), with comparable discrimination (AUC 0.775-0.777).
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