Predicting the Twenty-Year Risk of Cardiovascular Disease in Middle-Aged Chinese
METHODS: We prospectively followed 1105 participants of the Shanghai healthy worker cohort aged 35 to 64 years and free of CVD and cancer at baseline examination in 1992 for the development of CVD events (coronary death, myocardial infarction, and stroke) and all cause of death. Proportional hazard models were used to assess the hazard ratios (HRs) and 95% confidence intervals (95%CIs) of CVD events associated with risk factors. C statistics were used to assess predictive performance of an optimism-corrected model compared with the standard Framingham model for CVD events.
RESULTS: Among 1105 baseline CVD and cancer-free participants, the mean age was 44, with 76% males. Over the course of 22481 person-years available for analysis, there were 26 cases of coronary heart disease (myocardial infarction or/and coronary death), 75 cases of stroke (ischemic 63, hemorrhagic 12).The Framingham risk score was significantly predictive of incident coronary heart disease (HR: 1.12 [95% CI: 1.13 to 1.27], incident ischemic stroke 1.18 [95% CI: 1.113 to 1.25] and incident hemorrhagic stroke 1.30(1.22-1.53) per 1% increase in risk, respectively. On addition of body mass index (BMI) in Framingham standard model, the corrected area under curve increased from 0.682(95% CI, 0.625–0.0.738) to 0.772 (95% CI, 0.632–0.911) for predicting incidence of CVD events.
CONCLUSIONS: Stroke is more common than coronary heart disease in the Chinese population. Framingham CVD risk predictions perform well in the 20-year risk for both CHD and stroke. The inclusion of BMI improves 20-year risk for CVD events prediction in middle-aged Chinese.