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Validation of the pooled cohort risk score in an Asian population - a retrospective cohort study


Citation

Chia, Yook Chin and Lim, Hooi Min and Ching, Siew Mooi (2014) Validation of the pooled cohort risk score in an Asian population - a retrospective cohort study. BMC Cardiovascular Disorders, 14. art. no. 163. pp. 1-7. ISSN 1471-2261

Abstract / Synopsis

BACKGROUND: The Pooled Cohort Risk Equation was introduced by the American College of Cardiology (ACC) and American Heart Association (AHA) 2013 in their Blood Cholesterol Guideline to estimate the 10-year atherosclerotic cardiovascular disease (ASCVD) risk. However, absence of Asian ethnicity in the contemporary cohorts and limited studies to examine the use of the risk score limit the applicability of the equation in an Asian population. This study examines the validity of the pooled cohort risk score in a primary care setting and compares the cardiovascular risk using both the pooled cohort risk score and the Framingham General Cardiovascular Disease (CVD) risk score. METHODS: This is a 10-year retrospective cohort study of randomly selected patients aged 40-79 years. Baseline demographic data, co-morbidities and cardiovascular (CV) risk parameters were captured from patient records in 1998. Pooled cohort risk score and Framingham General CVD risk score for each patient were computed. All ASCVD events (nonfatal myocardial infarction, coronary heart disease (CHD) death, fatal and nonfatal stroke) occurring from 1998-2007 were recorded. RESULTS: A total of 922 patients were studied. In 1998, mean age was 57.5 ± 8.8 years with 66.7% female. There were 47% diabetic patients and 59.9% patients receiving anti-hypertensive treatment. More than 98% of patients with pooled cohort risk score ≥7.5% had FRS >10%. A total of 45 CVD events occurred, 22 (7.2%) in males and 23 (3.7%) in females. The median pooled cohort risk score for the population was 10.1 (IQR 4.7-20.6) while the actual ASCVD events that occurred was 4.9% (45/922). Our study showed moderate discrimination with AUC of 0.63. There was good calibration with Hosmer-Lemeshow test χ2 = 12.6, P = 0.12. CONCLUSIONS: The pooled cohort risk score appears to overestimate CV risk but this apparent over-prediction could be a result of treatment. In the absence of a validated score in an untreated population, the pooled cohort risk score appears to be appropriate for use in a primary care setting.


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Additional Metadata

Item Type: Article
Divisions: Faculty of Medicine and Health Science
Institute of Gerontology
DOI Number: https://doi.org/10.1186/1471-2261-14-163
Publisher: BioMed Central
Keywords: Pooled cohort risk score; Atherosclerotic cardiovascular disease; Validation; Asian population; Framingham risk score; Cardiovascular events; Primary care; Retrospective cohort; Malaysia
Depositing User: Nurul Ainie Mokhtar
Date Deposited: 12 Feb 2016 10:39
Last Modified: 12 Feb 2016 10:39
Altmetrics: http://www.altmetric.com/details.php?domain=psasir.upm.edu.my&doi=10.1186/1471-2261-14-163
URI: http://psasir.upm.edu.my/id/eprint/35961
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