Dataset Information

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

ABSTRACT: 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.A prospective cohort study within a national insurance system.18 health promotion centres nationwide between 1996 and 2001 in Korea.268?315 Koreans between the ages of 30 and 74?years without CHD at baseline.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).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.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.

SUBMITTER: Jee SH

PROVIDER: S-EPMC4039825 | biostudies-other | 2014

REPOSITORIES: biostudies-other

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

Jee Sun Ha SH Jang Yangsoo Y Oh Dong Joo DJ Oh Byung-Hee BH Lee Sang Hoon SH Park Seong-Wook SW Seung Ki-Bae KB Mok Yejin Y Jung Keum Ji KJ Kimm Heejin H Yun Young Duk YD Baek Soo Jin SJ Lee Duk Chul DC Choi Sung Hee SH Kim Moon Jong MJ Sung Jidong J Cho BeLong B Kim Eung Soo ES Yu Byung-Yeon BY Lee Tae-Yong TY Kim Jong Sung JS Lee Yong-Jin YJ Oh Jang-Kyun JK Kim Sung Hi SH Park Jong-Ku JK Koh Sang Baek SB Park Sat Byul SB Lee Soon Young SY Yoo Cheol-In CI Kim Moon Chan MC Kim Hong-Kyu HK Park Joo-Sung JS Kim Hyeon Chang HC Lee Gyu Jang GJ Woodward Mark M

BMJ open 20140521 5

<h4>Objective</h4>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.<h4>Design</h4>A prospective cohort study within a national insurance system.<h4>Setting</h4>18 health promotion centres nationwide between 1996 and 2001 in Korea.<h4>Participants</h4>268 315 Koreans between the ages of 30 and 74 years without CHD at baseline.<h4>Outcome measure</h4>Non-fatal or fa ...[more]

PMID: 24848088

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Project description:Objective To determine whether educational attainment is a causal risk factor in the development of coronary heart disease.Design Mendelian randomisation study, using genetic data as proxies for education to minimise confounding.Setting The main analysis used genetic data from two large consortia (CARDIoGRAMplusC4D and SSGAC), comprising 112 studies from predominantly high income countries. Findings from mendelian randomisation analyses were then compared against results from traditional observational studies (164 170 participants). Finally, genetic data from six additional consortia were analysed to investigate whether longer education can causally alter the common cardiovascular risk factors.Participants The main analysis was of 543 733 men and women (from CARDIoGRAMplusC4D and SSGAC), predominantly of European origin.Exposure A one standard deviation increase in the genetic predisposition towards higher education (3.6 years of additional schooling), measured by 162 genetic variants that have been previously associated with education.Main outcome measure Combined fatal and non-fatal coronary heart disease (63 746 events in CARDIoGRAMplusC4D).Results Genetic predisposition towards 3.6 years of additional education was associated with a one third lower risk of coronary heart disease (odds ratio 0.67, 95% confidence interval 0.59 to 0.77; P=3×10-8). This was comparable to findings from traditional observational studies (prevalence odds ratio 0.73, 0.68 to 0.78; incidence odds ratio 0.80, 0.76 to 0.83). Sensitivity analyses were consistent with a causal interpretation in which major bias from genetic pleiotropy was unlikely, although this remains an untestable possibility. Genetic predisposition towards longer education was additionally associated with less smoking, lower body mass index, and a favourable blood lipid profile.Conclusions This mendelian randomisation study found support for the hypothesis that low education is a causal risk factor in the development of coronary heart disease. Potential mechanisms could include smoking, body mass index, and blood lipids. In conjunction with the results from studies with other designs, these findings suggest that increasing education may result in substantial health benefits.

Project description:BACKGROUND:A Genetic risk score for coronary artery disease (CAD) improves the ability of predicting coronary heart disease (CHD). It is unclear whether i) the use of a CAD genetic risk score is superior to the measurement of coronary artery calcification (CAC) for CHD risk assessment and ii) the CHD risk assessment using a CAD genetic risk score differs between men and women. METHODS:We included 4041 participants (age-range: 45-76?years, 1919 men) of the Heinz Nixdorf Recall study without CHD or stroke at baseline. A standardized weighted CAD genetic risk score was constructed using 70 known genetic variants. The risk score was divided into quintiles (Q1-Q5). We specified low (Q1), intermediate (Q2-Q4) and high (Q5) genetic risk groups. Incident CHD was defined as fatal and non-fatal myocardial infarction, stroke and coronary death. The association between the genetic risk score and genetic risk groups with incident CHD was assessed using Cox models to estimate hazard ratios (HR) and 95%-confidence intervals (CI). The models were adjusted by age and sex (Model1), as well as by established CHD risk factors (RF) and CAC (Model2). The analyses were further stratified by sex and controlled for multiple testing. RESULTS:During a median follow-up time of 11.6?±?3.7?years, 343 participants experienced CHD events (219 men). Per-standard deviation (SD) increase in the genetic risk score was associated with 18% increased risk for incident CHD (Model1: p?=?0.002) which did not change after full adjustment (Model2: HR?=?1.18 per-SD (p?=?0.003)). In Model2 we observed a 60% increased CHD risk in the high (p?=?0.009) compared to the low genetic risk group. Stratifying by sex, only men showed statistically significantly higher risk for CHD (Model2: HR?=?1.23 per-SD (p?=?0.004); intermediate: HR?=?1.52 (p?=?0.04) and high: HR?=?1.88 (p?=?0.008)) with no statistically significant risk observed in women. CONCLUSION:Our results suggest that the CAD genetic risk score could be useful for CHD risk prediction, at least in men belonging to the higher genetic risk group, but it does not outbalance the value of CT-based quantification of CAC which works independently on both men and women and allows better risk stratification in both the genders.

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

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

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