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BMJ Open. 2014 May 21;4(5):e005025. doi: 10.1136/bmjopen-2014-005025.

A coronary heart disease prediction model: the Korean Heart Study.

Author information

1
Department of Epidemiology and Health Promotion, and Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
2
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea.
3
Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea.
4
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
5
Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
6
Division of Cardiology, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
7
Department of Internal Medicine, The Catholic University of Korea, School of Medicine, Seoul, Republic of Korea.
8
Health Insurance Policy Research Institute, National Health Insurance Service, Seoul, Republic of Korea.
9
Department of Family Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
10
Seoul National University College of Medicine, Bundang Hospital, Sungnam, Republic of Korea.
11
Department of Family Medicine, CHA Bundang Medical Center, CHA University, Sungnam, Republic of Korea.
12
Division of Cardiology, Department of Internal Medicine, Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
13
Department of Family Medicine, Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea.
14
Department of Family Medicine, Daejeon Sun General Hospital, Daejeon, Republic of Korea.
15
Department of Family Medicine, Konyang University Hospital, Daejeon, Republic of Korea.
16
Department of Preventive Medicine and Public Health, College of Medicine, Chungnam National University, Daejeon, Republic of Korea.
17
Department of Family Medicine, School of Medicine, Chungnam National University, Daejeon, Republic of Korea.
18
Department of Occupational and Environmental Medicine, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea.
19
Department of Occupational and Environmental Medicine, Daejeon Eulji University Hospital, Daejeon, Republic of Korea.
20
Department of Family Medicine, Daegu Catholic University Hospital, Daegu, Republic of Korea.
21
Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
22
Institute of Genomic Cohort, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
23
Department of Family Practice and Community Health, Ajou University School of Medicine, Suwon, Republic of Korea.
24
Department of Preventive Medicine, Ajou University School of Medicine, Suwon, Republic of Korea.
25
Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
26
Department of Family Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
27
The Health Screening and Promotion Center, Asan Medical Center, Seoul, Republic of Korea.
28
Department of Family Medicine, Dong-A University Medical Center, Busan, Republic of Korea.
29
Department of Preventive Medicine and Public Health, Yonsei University College of Medicine, Seoul, Republic of Korea.
30
Korea Medical Institute, Seoul, Republic of Korea.
31
Nuffield Department of Population Health, The George Institute for Global Health, University of Oxford, Oxford, UK The George Institute for Global Health, University of Sydney, Sydney, Australia Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

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.

KEYWORDS:

Epidemiology

PMID:
24848088
PMCID:
PMC4039825
DOI:
10.1136/bmjopen-2014-005025
[Indexed for MEDLINE]
Free PMC Article
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