World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions
World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions
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DOI：
10.1016/s2214-109x(19)30318-3
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发表时间：
2019-10-01
影响因子：
34.3
通讯作者：
Hadaegh, Farzad
中科院分区：
文献类型：
--
作者：
Di Angelantonio, Emanuele;Kaptoge, Stephen;Hadaegh, Farzad
为帮助低收入和中等收入国家采用心血管疾病风险预测方法，世卫组织已开展一项工作，以开发、评估和说明修订后的风险模型。在这里，我们报告的推导，验证和说明修订后的世卫组织心血管疾病的风险预测图表，已适应的情况下，21 global regions.Methods在这个模型的修订倡议，我们得出了10年的风险预测模型，致命和非致命的心血管疾病（即心肌梗死和中风）使用个人参与者的数据从新兴的风险因素协作。模型包括年龄、吸烟状况、收缩压、糖尿病史和总胆固醇。为了推导，我们纳入了40-80岁的参与者，他们没有已知的基线心血管疾病史，随访至首次心肌梗死，致命性冠心病或中风事件。我们使用来自全球21个地区的年龄特异性和性别特异性发病率和风险因素值重新校准了模型。对于外部验证，我们分析了与模型推导中使用的研究不同的个体参与者数据。我们举例说明模型分析数据，进一步123 743个人从79个国家的调查收集与WHO STEPwise Approach to Surveillance.Findings我们的风险模型推导涉及376 177个人从85个队列，和19 333事件心血管事件记录在10年的后续行动。衍生的风险预测模型在外部验证队列（19个队列，1 096 061人，25 950起心血管疾病事件）中区分良好，Harrell C指数范围为0.685（95%CI 0.001）。629-0 741）至0. 833（0 . 783-0- 882）。对于给定的风险因素概况，我们发现全球各地区的10年预测风险估计值存在很大差异。例如，一名60岁男性吸烟者，无糖尿病，收缩压140 mm Hg，总胆固醇5 mmol/L，其心血管疾病风险估计值从拉丁美洲安第斯山脉的11%到中亚的30%不等。当应用于79个国家的数据时（大多数是低收入和中等收入国家），估计40-64岁的个人风险大于20%的比例从乌干达的不到1%到埃及的超过16%不等。并验证了新的世卫组织风险预测模型，以估计21个全球疾病负担地区的心血管疾病风险。这些模型的广泛使用可以提高减少全球心血管疾病负担的准确性，实用性和可持续性。版权所有（C）2019作者。爱思唯尔有限公司出版
Background To help adapt cardiovascular disease risk prediction approaches to low-income and middle-income countries, WHO has convened an effort to develop, evaluate, and illustrate revised risk models. Here, we report the derivation, validation, and illustration of the revised WHO cardiovascular disease risk prediction charts that have been adapted to the circumstances of 21 global regions.Methods In this model revision initiative, we derived 10-year risk prediction models for fatal and non-fatal cardiovascular disease (ie, myocardial infarction and stroke) using individual participant data from the Emerging Risk Factors Collaboration. Models included information on age, smoking status, systolic blood pressure, history of diabetes, and total cholesterol. For derivation, we included participants aged 40-80 years without a known baseline history of cardiovascular disease, who were followed up until the first myocardial infarction, fatal coronary heart disease, or stroke event. We recalibrated models using age-specific and sex-specific incidences and risk factor values available from 21 global regions. For external validation, we analysed individual participant data from studies distinct from those used in model derivation. We illustrated models by analysing data on a further 123 743 individuals from surveys in 79 countries collected with the WHO STEPwise Approach to Surveillance.Findings Our risk model derivation involved 376 177 individuals from 85 cohorts, and 19 333 incident cardiovascular events recorded during 10 years of follow-up. The derived risk prediction models discriminated well in external validation cohorts (19 cohorts, 1 096 061 individuals, 25 950 cardiovascular disease events), with Harrell's C indices ranging from 0.685 (95% CI 0 . 629-0 741) to 0.833 (0 . 783-0- 882). For a given risk factor profile, we found substantial variation across global regions in the estimated 10-year predicted risk. For example, estimated cardiovascular disease risk for a 60-year-old male smoker without diabetes and with systolic blood pressure of 140 mm Hg and total cholesterol of 5 mmol/L ranged from 11% in Andean Latin America to 30% in central Asia. When applied to data from 79 countries (mostly low-income and middle-income countries), the proportion of individuals aged 40-64 years estimated to be at greater than 20% risk ranged from less than 1% in Uganda to more than 16% in Egypt.Interpretation We have derived, calibrated, and validated new WHO risk prediction models to estimate cardiovascular disease risk in 21 Global Burden of Disease regions. The widespread use of these models could enhance the accuracy, practicability, and sustainability of efforts to reduce the burden of cardiovascular disease worldwide. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.