Background: Cardiovascular risk equations are traditionally derived from the Framingham Study. The accuracy of this approach in Asian populations, where resources for risk factor measurement may be limited, is unclear.
Objective: To compare “low-information” equations (derived using only age, systolic blood pressure, total cholesterol and smoking status) derived from the Framingham Study with those derived from the Asian cohorts, on the accuracy of cardiovascular risk prediction.
Design: Separate equations to predict the 8-year risk of a cardiovascular event were derived from Asian and Framingham cohorts. The performance of these equations, and a subsequently “recalibrated” Framingham equation, were evaluated among participants from independent Chinese cohorts.
Setting: Six cohort studies from Japan, Korea and Singapore (Asian cohorts); six cohort studies from China; the Framingham Study from the US.
Participants: 172 077 participants from the Asian cohorts; 25 682 participants from Chinese cohorts and 6053 participants from the Framingham Study.
Main results: In the Chinese cohorts, 542 cardiovascular events occurred during 8 years of follow-up. Both the Asian cohorts and the Framingham equations discriminated cardiovascular risk well in the Chinese cohorts; the area under the receiver–operator characteristic curve was at least 0.75 for men and women. However, the Framingham risk equation systematically overestimated risk in the Chinese cohorts by an average of 276% among men and 102% among women. The corresponding average overestimation using the Asian cohorts equation was 11% and 10%, respectively. Recalibrating the Framingham risk equation using cardiovascular disease incidence from the non-Chinese Asian cohorts led to an overestimation of risk by an average of 4% in women and underestimation of risk by an average of 2% in men.
Interpretation: A low-information Framingham cardiovascular risk prediction tool, which, when recalibrated with contemporary data, is likely to estimate future cardiovascular risk with similar accuracy in Asian populations as tools developed from data on local cohorts.
- APCSC, Asia Pacific Cohort Studies Collaboration
- EGAT, Electricity Generating Authority of Thailand
- ICD, International Classification of Disease
- SBP, systolic blood pressure
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Funding: This project has received grants from the National Health and Medical Research Council of Australia and the Health Research Council of New Zealand, and an unrestricted educational grant from Pfizer Inc. None of the sponsors had any role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
Data from the Framingham Heart Study and the Framingham Offspring Study were obtained from the US National Heart Lung and Blood Institute; the paper does not necessarily reflect their views.
The Asia Pacific Cohort Studies Collaboration included the following. Writing committee: F Barzi, A Patel, D Gu, P Sritara, TH Lam, A Rodgers, M Woodward.
Executive committee: M Woodward, X Fang, DF Gu, Y Imai, TH Lam, WH Pan, A Rodgers, I Suh, HJ Sun, H Ueshima.
Statistical analyses: F Barzi, V Parag, M Woodward.
Participating studies and principal collaborators in the APCSC: Aito Town: A Okayama, H Ueshima, H Maegawa; Akabane:* M Nakamura, N Aoki; Anzhen02:* ZS Wu; Anzhen: CH Yao, ZS Wu; Australian Longitudinal Study of Aging: G Andrews; Australian National Heart Foundation: TA Welborn; Beijing Aging: Z Tang; Beijing Steelworkers: LS Liu, JX Xie; Blood Donors’ Health: R Norton, S Ameratunga, S MacMahon, G Whitlock; Busselton: MW Knuiman; Canberra-Queanbeyan: H Christensen; Capital Iron and Steel Company:* XG Wu; CISCH: J Zhou, XH Yu; Civil Service Workers: A Tamakoshi; CVDFACTS: WH Pan; East Beijing: ZL Wu, LQ Chen, GL Shan; Electricity Generating Authority of Thailand:* P Sritara; Fangshan:* DF Gu, XF Duan; Fletcher Challenge: S MacMahon, R Norton, G Whitlock, R Jackson; Guangzhou: YH Li; Guangzhou Occupational: TH Lam, CQ Jiang; Hisayama:* M Fujishima, Y Kiyohara, H Iwamoto; Hong Kong: the J Woo, SC Ho; Huashan:* Z Hong, MS Huang, B Zhou; Kinmen: JL Fuh; Konan: H Ueshima, Y Kita, SR Choudhury; KMIC:* I Suh, SH Jee, IS Kim; Melbourne: GG Giles; Miyama: T Hashimoto, K Sakata; Newcastle: A Dobson; Ohasama: Y Imai, T Ohkubo, A Hozawa; Perth: K Jamrozik, M Hobbs, R Broadhurst; Saitama: K Nakachi; Seven Cities: XH Fang, SC Li, QD Yang; Shanghai Factory Workers: ZM Chen; Shibata: the H Tanaka; Shigaraki Town: Y Kita, A Nozaki, H Ueshima; Shirakawa:* H Horibe, Y Matsutani, M Kagaya; Singapore Heart:* K Hughes, J Lee; Singapore NHS92:* D Heng, SK Chew; Six Cohorts:* BF Zhou, HY Zhang; Tanno/Soubetsu: K Shimamoto, S Saitoh; Tianjin: ZZ Li, HY Zhang; Western Australia AAA Screenees: P Norman, K Jamrozik; Xi’an: Y He, TH Lam; Yunnan: SX Yao.
↵*These studies provided data used in this paper.