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, Yejin Mok, Keum Ji Jung, Heejin Kimm, Young Duk Yun, Soo Jin Baek, Duk Chul Lee, Sung Hee Choi, Moon Jong Kim, Jidong Sung, Be Long 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

ASJC Scopus subject areas

  • Medicine(all)

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    Jee, S. H., Jang, Y., Oh, D. J., Oh, B. H., Lee, S. H., Park, S. W., Seung, K. B., Mok, Y., Jung, K. J., Kimm, H., Yun, Y. D., Baek, S. J., Lee, D. C., Choi, S. H., Kim, M. J., Sung, J., Cho, B. L., Kim, E. S., Yu, B. Y., ... 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