A coronary heart disease prediction model: The Korean heart study

Sun Ha Jee, Yangsoo Jang, Dong Joo Oh, Byung Hee Oh, Sang Hoon Lee, Seong Wook Park, Ki Bae Seung, Ye Jin Mok, Keum Ji Jung, Heejin Kimm, Young Duk Yun, Soo Jin Baek, Duk Chul Lee, Sung Hee Choi, Moon Jong Kim, Jidong Sung, BeLong Cho, Eung Soo Kim, Byung Yeon Yu, Tae Yong LeeJong Sung Kim, Yong Jin Lee, Jang Kyun Oh, Sung Hi Kim, Jong Ku Park, Sang Baek Koh, Sat Byul Park, Soon Young Lee, Cheol In Yoo, Moon Chan Kim, Hong Kyu Kim, Joo Sung Park, Hyeon Chang Kim, Gyu Jang Lee, Mark Woodward

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Article numbere005025
JournalBMJ Open
Volume4
Issue number5
DOIs
StatePublished - 2014

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Coronary Disease
Cohort Studies
ROC Curve
HDL Cholesterol
Incidence
Korea
Insurance
Health Promotion
LDL Cholesterol
Population
Triglycerides
Heart Rate

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Jee, S. H., Jang, Y., Oh, D. J., Oh, B. H., Lee, S. H., Park, S. W., ... Woodward, M. (2014). A coronary heart disease prediction model: The Korean heart study. BMJ Open, 4(5), [e005025]. https://doi.org/10.1136/bmjopen-2014-005025

A coronary heart disease prediction model : The Korean heart study. / Jee, Sun Ha; Jang, Yangsoo; Oh, Dong Joo; Oh, Byung Hee; Lee, Sang Hoon; Park, Seong Wook; Seung, Ki Bae; Mok, Ye Jin; Jung, Keum Ji; Kimm, Heejin; Yun, Young Duk; Baek, Soo Jin; Lee, Duk Chul; Choi, Sung Hee; Kim, Moon Jong; Sung, Jidong; Cho, BeLong; Kim, Eung Soo; Yu, Byung Yeon; Lee, Tae Yong; Kim, Jong Sung; Lee, Yong Jin; Oh, Jang Kyun; Kim, Sung Hi; Park, Jong Ku; Koh, Sang Baek; Park, Sat Byul; Lee, Soon Young; Yoo, Cheol In; Kim, Moon Chan; Kim, Hong Kyu; Park, Joo Sung; Kim, Hyeon Chang; Lee, Gyu Jang; Woodward, Mark.

In: BMJ Open, Vol. 4, No. 5, e005025, 2014.

Research output: Contribution to journalArticle

Jee, SH, Jang, Y, Oh, DJ, Oh, BH, Lee, SH, Park, SW, Seung, KB, Mok, YJ, Jung, KJ, Kimm, H, Yun, YD, Baek, SJ, Lee, DC, Choi, SH, Kim, MJ, Sung, J, Cho, B, Kim, ES, Yu, BY, Lee, TY, Kim, JS, Lee, YJ, Oh, JK, Kim, SH, Park, JK, Koh, SB, Park, SB, Lee, SY, Yoo, CI, Kim, MC, Kim, HK, Park, JS, Kim, HC, Lee, GJ & Woodward, M 2014, 'A coronary heart disease prediction model: The Korean heart study', BMJ Open, vol. 4, no. 5, e005025. https://doi.org/10.1136/bmjopen-2014-005025
Jee, Sun Ha ; Jang, Yangsoo ; Oh, Dong Joo ; Oh, Byung Hee ; Lee, Sang Hoon ; Park, Seong Wook ; Seung, Ki Bae ; Mok, Ye Jin ; Jung, Keum Ji ; Kimm, Heejin ; Yun, Young Duk ; Baek, Soo Jin ; Lee, Duk Chul ; Choi, Sung Hee ; Kim, Moon Jong ; Sung, Jidong ; Cho, BeLong ; Kim, Eung Soo ; Yu, Byung Yeon ; Lee, Tae Yong ; Kim, Jong Sung ; Lee, Yong Jin ; Oh, Jang Kyun ; Kim, Sung Hi ; Park, Jong Ku ; Koh, Sang Baek ; Park, Sat Byul ; Lee, Soon Young ; Yoo, Cheol In ; Kim, Moon Chan ; Kim, Hong Kyu ; Park, Joo Sung ; Kim, Hyeon Chang ; Lee, Gyu Jang ; Woodward, Mark. / A coronary heart disease prediction model : The Korean heart study. In: BMJ Open. 2014 ; Vol. 4, No. 5.
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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.",
author = "Jee, {Sun Ha} and Yangsoo Jang and Oh, {Dong Joo} and Oh, {Byung Hee} and Lee, {Sang Hoon} and Park, {Seong Wook} and Seung, {Ki Bae} and Mok, {Ye Jin} and Jung, {Keum Ji} and Heejin Kimm and Yun, {Young Duk} and Baek, {Soo Jin} and Lee, {Duk Chul} and Choi, {Sung Hee} and Kim, {Moon Jong} and Jidong Sung and BeLong Cho and Kim, {Eung Soo} and Yu, {Byung Yeon} and Lee, {Tae Yong} and Kim, {Jong Sung} and Lee, {Yong Jin} and Oh, {Jang Kyun} and Kim, {Sung Hi} and Park, {Jong Ku} and Koh, {Sang Baek} and Park, {Sat Byul} and Lee, {Soon Young} and Yoo, {Cheol In} and Kim, {Moon Chan} and Kim, {Hong Kyu} and Park, {Joo Sung} and Kim, {Hyeon Chang} and Lee, {Gyu Jang} and Mark Woodward",
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T1 - A coronary heart disease prediction model

T2 - The Korean heart study

AU - Jee, Sun Ha

AU - Jang, Yangsoo

AU - Oh, Dong Joo

AU - Oh, Byung Hee

AU - Lee, Sang Hoon

AU - Park, Seong Wook

AU - Seung, Ki Bae

AU - Mok, Ye Jin

AU - Jung, Keum Ji

AU - Kimm, Heejin

AU - Yun, Young Duk

AU - Baek, Soo Jin

AU - Lee, Duk Chul

AU - Choi, Sung Hee

AU - Kim, Moon Jong

AU - Sung, Jidong

AU - Cho, BeLong

AU - Kim, Eung Soo

AU - Yu, Byung Yeon

AU - Lee, Tae Yong

AU - Kim, Jong Sung

AU - Lee, Yong Jin

AU - Oh, Jang Kyun

AU - Kim, Sung Hi

AU - Park, Jong Ku

AU - Koh, Sang Baek

AU - Park, Sat Byul

AU - Lee, Soon Young

AU - Yoo, Cheol In

AU - Kim, Moon Chan

AU - Kim, Hong Kyu

AU - Park, Joo Sung

AU - Kim, Hyeon Chang

AU - Lee, Gyu Jang

AU - Woodward, Mark

PY - 2014

Y1 - 2014

N2 - 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.

AB - 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.

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