World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions

Stephen Kaptoge, Lisa Pennells, Dirk De Bacquer, Marie Therese Cooney, Maryam Kavousi, Gretchen Stevens, Leanne Margaret Riley, Stefan Savin, Taskeen Khan, Servet Altay, Philippe Amouyel, Gerd Assmann, Steven Bell, Yoav Ben-Shlomo, Lisa Berkman, Joline W. Beulens, Cecilia Björkelund, Michael Blaha, Dan G. Blazer, Thomas BoltonRuth Bonita Beaglehole, Hermann Brenner, Eric J. Brunner, Edoardo Casiglia, Parinya Chamnan, Yeun Hyang Choi, Rajiv Chowdry, Sean Coady, Carlos J. Crespo, Mary Cushman, Gilles R. Dagenais, Ralph B. D'Agostino, Makoto Daimon, Karina W. Davidson, Gunnar Engström, Ian Ford, John Gallacher, Ron T. Gansevoort, Thomas Andrew Gaziano, Simona Giampaoli, Greg Grandits, Sameline Grimsgaard, Diederick E. Grobbee, Vilmundur Gudnason, Qi Guo, Hanna Tolonen, Steve Humphries, Hiroyasu Iso, J. Wouter Jukema, Jussi Kauhanen, Andre Pascal Kengne, Davood Khalili, Wolfgang Koenig, Daan Kromhout, Harlan Krumholz, T. H. Lam, Gail Laughlin, Alejandro Marín Ibañez, Tom W. Meade, Karel G.M. Moons, Paul J. Nietert, Toshiharu Ninomiya, Børge G. Nordestgaard, Christopher O'Donnell, Luigi Palmieri, Anushka Patel, Pablo Perel, Jackie F. Price, Rui Providencia, Paul M. Ridker, Beatriz Rodriguez, Annika Rosengren, Ronan Roussel, Masaru Sakurai, Veikko Salomaa, Shinichi Sato, Ben Schöttker, Nawar Shara, Jonathan E. Shaw, Hee Choon Shin, Leon A. Simons, Eleni Sofianopoulou, Johan Sundström, Henry Völzke, Robert B. Wallace, Nicholas J. Wareham, Peter Willeit, David Wood, Angela Wood, Dong Zhao, Mark Woodward, Goodarz Danaei, Gregory Roth, Shanthi Mendis, Oyere Onuma, Cherian Varghese, Majid Ezzati, Ian Graham, Rod Jackson, John Danesh, Emanuele Di Angelantonio

Research output: Contribution to journalArticle

Abstract

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. Funding: World Health Organization, British Heart Foundation (BHF), BHF Cambridge Centre for Research Excellence, UK Medical Research Council, and National Institute for Health Research.

Original languageEnglish (US)
Pages (from-to)e1332-e1345
JournalThe Lancet Global Health
Volume7
Issue number10
DOIs
StatePublished - Oct 2019

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Cardiovascular Diseases
Blood Pressure
Stroke
Myocardial Infarction
Cholesterol
Central Asia
Uganda
Latin America
Egypt
National Institutes of Health (U.S.)
Research
Coronary Disease
Biomedical Research
Smoking
Incidence

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Kaptoge, S., Pennells, L., De Bacquer, D., Cooney, M. T., Kavousi, M., Stevens, G., ... Di Angelantonio, E. (2019). World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions. The Lancet Global Health, 7(10), e1332-e1345. https://doi.org/10.1016/S2214-109X(19)30318-3

World Health Organization cardiovascular disease risk charts : revised models to estimate risk in 21 global regions. / Kaptoge, Stephen; Pennells, Lisa; De Bacquer, Dirk; Cooney, Marie Therese; Kavousi, Maryam; Stevens, Gretchen; Riley, Leanne Margaret; Savin, Stefan; Khan, Taskeen; Altay, Servet; Amouyel, Philippe; Assmann, Gerd; Bell, Steven; Ben-Shlomo, Yoav; Berkman, Lisa; Beulens, Joline W.; Björkelund, Cecilia; Blaha, Michael; Blazer, Dan G.; Bolton, Thomas; Bonita Beaglehole, Ruth; Brenner, Hermann; Brunner, Eric J.; Casiglia, Edoardo; Chamnan, Parinya; Choi, Yeun Hyang; Chowdry, Rajiv; Coady, Sean; Crespo, Carlos J.; Cushman, Mary; Dagenais, Gilles R.; D'Agostino, Ralph B.; Daimon, Makoto; Davidson, Karina W.; Engström, Gunnar; Ford, Ian; Gallacher, John; Gansevoort, Ron T.; Gaziano, Thomas Andrew; Giampaoli, Simona; Grandits, Greg; Grimsgaard, Sameline; Grobbee, Diederick E.; Gudnason, Vilmundur; Guo, Qi; Tolonen, Hanna; Humphries, Steve; Iso, Hiroyasu; Jukema, J. Wouter; Kauhanen, Jussi; Kengne, Andre Pascal; Khalili, Davood; Koenig, Wolfgang; Kromhout, Daan; Krumholz, Harlan; Lam, T. H.; Laughlin, Gail; Marín Ibañez, Alejandro; Meade, Tom W.; Moons, Karel G.M.; Nietert, Paul J.; Ninomiya, Toshiharu; Nordestgaard, Børge G.; O'Donnell, Christopher; Palmieri, Luigi; Patel, Anushka; Perel, Pablo; Price, Jackie F.; Providencia, Rui; Ridker, Paul M.; Rodriguez, Beatriz; Rosengren, Annika; Roussel, Ronan; Sakurai, Masaru; Salomaa, Veikko; Sato, Shinichi; Schöttker, Ben; Shara, Nawar; Shaw, Jonathan E.; Shin, Hee Choon; Simons, Leon A.; Sofianopoulou, Eleni; Sundström, Johan; Völzke, Henry; Wallace, Robert B.; Wareham, Nicholas J.; Willeit, Peter; Wood, David; Wood, Angela; Zhao, Dong; Woodward, Mark; Danaei, Goodarz; Roth, Gregory; Mendis, Shanthi; Onuma, Oyere; Varghese, Cherian; Ezzati, Majid; Graham, Ian; Jackson, Rod; Danesh, John; Di Angelantonio, Emanuele.

In: The Lancet Global Health, Vol. 7, No. 10, 10.2019, p. e1332-e1345.

Research output: Contribution to journalArticle

Kaptoge, S, Pennells, L, De Bacquer, D, Cooney, MT, Kavousi, M, Stevens, G, Riley, LM, Savin, S, Khan, T, Altay, S, Amouyel, P, Assmann, G, Bell, S, Ben-Shlomo, Y, Berkman, L, Beulens, JW, Björkelund, C, Blaha, M, Blazer, DG, Bolton, T, Bonita Beaglehole, R, Brenner, H, Brunner, EJ, Casiglia, E, Chamnan, P, Choi, YH, Chowdry, R, Coady, S, Crespo, CJ, Cushman, M, Dagenais, GR, D'Agostino, RB, Daimon, M, Davidson, KW, Engström, G, Ford, I, Gallacher, J, Gansevoort, RT, Gaziano, TA, Giampaoli, S, Grandits, G, Grimsgaard, S, Grobbee, DE, Gudnason, V, Guo, Q, Tolonen, H, Humphries, S, Iso, H, Jukema, JW, Kauhanen, J, Kengne, AP, Khalili, D, Koenig, W, Kromhout, D, Krumholz, H, Lam, TH, Laughlin, G, Marín Ibañez, A, Meade, TW, Moons, KGM, Nietert, PJ, Ninomiya, T, Nordestgaard, BG, O'Donnell, C, Palmieri, L, Patel, A, Perel, P, Price, JF, Providencia, R, Ridker, PM, Rodriguez, B, Rosengren, A, Roussel, R, Sakurai, M, Salomaa, V, Sato, S, Schöttker, B, Shara, N, Shaw, JE, Shin, HC, Simons, LA, Sofianopoulou, E, Sundström, J, Völzke, H, Wallace, RB, Wareham, NJ, Willeit, P, Wood, D, Wood, A, Zhao, D, Woodward, M, Danaei, G, Roth, G, Mendis, S, Onuma, O, Varghese, C, Ezzati, M, Graham, I, Jackson, R, Danesh, J & Di Angelantonio, E 2019, 'World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions', The Lancet Global Health, vol. 7, no. 10, pp. e1332-e1345. https://doi.org/10.1016/S2214-109X(19)30318-3
Kaptoge, Stephen ; Pennells, Lisa ; De Bacquer, Dirk ; Cooney, Marie Therese ; Kavousi, Maryam ; Stevens, Gretchen ; Riley, Leanne Margaret ; Savin, Stefan ; Khan, Taskeen ; Altay, Servet ; Amouyel, Philippe ; Assmann, Gerd ; Bell, Steven ; Ben-Shlomo, Yoav ; Berkman, Lisa ; Beulens, Joline W. ; Björkelund, Cecilia ; Blaha, Michael ; Blazer, Dan G. ; Bolton, Thomas ; Bonita Beaglehole, Ruth ; Brenner, Hermann ; Brunner, Eric J. ; Casiglia, Edoardo ; Chamnan, Parinya ; Choi, Yeun Hyang ; Chowdry, Rajiv ; Coady, Sean ; Crespo, Carlos J. ; Cushman, Mary ; Dagenais, Gilles R. ; D'Agostino, Ralph B. ; Daimon, Makoto ; Davidson, Karina W. ; Engström, Gunnar ; Ford, Ian ; Gallacher, John ; Gansevoort, Ron T. ; Gaziano, Thomas Andrew ; Giampaoli, Simona ; Grandits, Greg ; Grimsgaard, Sameline ; Grobbee, Diederick E. ; Gudnason, Vilmundur ; Guo, Qi ; Tolonen, Hanna ; Humphries, Steve ; Iso, Hiroyasu ; Jukema, J. Wouter ; Kauhanen, Jussi ; Kengne, Andre Pascal ; Khalili, Davood ; Koenig, Wolfgang ; Kromhout, Daan ; Krumholz, Harlan ; Lam, T. H. ; Laughlin, Gail ; Marín Ibañez, Alejandro ; Meade, Tom W. ; Moons, Karel G.M. ; Nietert, Paul J. ; Ninomiya, Toshiharu ; Nordestgaard, Børge G. ; O'Donnell, Christopher ; Palmieri, Luigi ; Patel, Anushka ; Perel, Pablo ; Price, Jackie F. ; Providencia, Rui ; Ridker, Paul M. ; Rodriguez, Beatriz ; Rosengren, Annika ; Roussel, Ronan ; Sakurai, Masaru ; Salomaa, Veikko ; Sato, Shinichi ; Schöttker, Ben ; Shara, Nawar ; Shaw, Jonathan E. ; Shin, Hee Choon ; Simons, Leon A. ; Sofianopoulou, Eleni ; Sundström, Johan ; Völzke, Henry ; Wallace, Robert B. ; Wareham, Nicholas J. ; Willeit, Peter ; Wood, David ; Wood, Angela ; Zhao, Dong ; Woodward, Mark ; Danaei, Goodarz ; Roth, Gregory ; Mendis, Shanthi ; Onuma, Oyere ; Varghese, Cherian ; Ezzati, Majid ; Graham, Ian ; Jackson, Rod ; Danesh, John ; Di Angelantonio, Emanuele. / World Health Organization cardiovascular disease risk charts : revised models to estimate risk in 21 global regions. In: The Lancet Global Health. 2019 ; Vol. 7, No. 10. pp. e1332-e1345.
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abstract = "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. Funding: World Health Organization, British Heart Foundation (BHF), BHF Cambridge Centre for Research Excellence, UK Medical Research Council, and National Institute for Health Research.",
author = "Stephen Kaptoge and Lisa Pennells and {De Bacquer}, Dirk and Cooney, {Marie Therese} and Maryam Kavousi and Gretchen Stevens and Riley, {Leanne Margaret} and Stefan Savin and Taskeen Khan and Servet Altay and Philippe Amouyel and Gerd Assmann and Steven Bell and Yoav Ben-Shlomo and Lisa Berkman and Beulens, {Joline W.} and Cecilia Bj{\"o}rkelund and Michael Blaha and Blazer, {Dan G.} and Thomas Bolton and {Bonita Beaglehole}, Ruth and Hermann Brenner and Brunner, {Eric J.} and Edoardo Casiglia and Parinya Chamnan and Choi, {Yeun Hyang} and Rajiv Chowdry and Sean Coady and Crespo, {Carlos J.} and Mary Cushman and Dagenais, {Gilles R.} and D'Agostino, {Ralph B.} and Makoto Daimon and Davidson, {Karina W.} and Gunnar Engstr{\"o}m and Ian Ford and John Gallacher and Gansevoort, {Ron T.} and Gaziano, {Thomas Andrew} and Simona Giampaoli and Greg Grandits and Sameline Grimsgaard and Grobbee, {Diederick E.} and Vilmundur Gudnason and Qi Guo and Hanna Tolonen and Steve Humphries and Hiroyasu Iso and Jukema, {J. Wouter} and Jussi Kauhanen and Kengne, {Andre Pascal} and Davood Khalili and Wolfgang Koenig and Daan Kromhout and Harlan Krumholz and Lam, {T. H.} and Gail Laughlin and {Mar{\'i}n Iba{\~n}ez}, Alejandro and Meade, {Tom W.} and Moons, {Karel G.M.} and Nietert, {Paul J.} and Toshiharu Ninomiya and Nordestgaard, {B{\o}rge G.} and Christopher O'Donnell and Luigi Palmieri and Anushka Patel and Pablo Perel and Price, {Jackie F.} and Rui Providencia and Ridker, {Paul M.} and Beatriz Rodriguez and Annika Rosengren and Ronan Roussel and Masaru Sakurai and Veikko Salomaa and Shinichi Sato and Ben Sch{\"o}ttker and Nawar Shara and Shaw, {Jonathan E.} and Shin, {Hee Choon} and Simons, {Leon A.} and Eleni Sofianopoulou and Johan Sundstr{\"o}m and Henry V{\"o}lzke and Wallace, {Robert B.} and Wareham, {Nicholas J.} and Peter Willeit and David Wood and Angela Wood and Dong Zhao and Mark Woodward and Goodarz Danaei and Gregory Roth and Shanthi Mendis and Oyere Onuma and Cherian Varghese and Majid Ezzati and Ian Graham and Rod Jackson and John Danesh and {Di Angelantonio}, Emanuele",
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month = "10",
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language = "English (US)",
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TY - JOUR

T1 - World Health Organization cardiovascular disease risk charts

T2 - revised models to estimate risk in 21 global regions

AU - Kaptoge, Stephen

AU - Pennells, Lisa

AU - De Bacquer, Dirk

AU - Cooney, Marie Therese

AU - Kavousi, Maryam

AU - Stevens, Gretchen

AU - Riley, Leanne Margaret

AU - Savin, Stefan

AU - Khan, Taskeen

AU - Altay, Servet

AU - Amouyel, Philippe

AU - Assmann, Gerd

AU - Bell, Steven

AU - Ben-Shlomo, Yoav

AU - Berkman, Lisa

AU - Beulens, Joline W.

AU - Björkelund, Cecilia

AU - Blaha, Michael

AU - Blazer, Dan G.

AU - Bolton, Thomas

AU - Bonita Beaglehole, Ruth

AU - Brenner, Hermann

AU - Brunner, Eric J.

AU - Casiglia, Edoardo

AU - Chamnan, Parinya

AU - Choi, Yeun Hyang

AU - Chowdry, Rajiv

AU - Coady, Sean

AU - Crespo, Carlos J.

AU - Cushman, Mary

AU - Dagenais, Gilles R.

AU - D'Agostino, Ralph B.

AU - Daimon, Makoto

AU - Davidson, Karina W.

AU - Engström, Gunnar

AU - Ford, Ian

AU - Gallacher, John

AU - Gansevoort, Ron T.

AU - Gaziano, Thomas Andrew

AU - Giampaoli, Simona

AU - Grandits, Greg

AU - Grimsgaard, Sameline

AU - Grobbee, Diederick E.

AU - Gudnason, Vilmundur

AU - Guo, Qi

AU - Tolonen, Hanna

AU - Humphries, Steve

AU - Iso, Hiroyasu

AU - Jukema, J. Wouter

AU - Kauhanen, Jussi

AU - Kengne, Andre Pascal

AU - Khalili, Davood

AU - Koenig, Wolfgang

AU - Kromhout, Daan

AU - Krumholz, Harlan

AU - Lam, T. H.

AU - Laughlin, Gail

AU - Marín Ibañez, Alejandro

AU - Meade, Tom W.

AU - Moons, Karel G.M.

AU - Nietert, Paul J.

AU - Ninomiya, Toshiharu

AU - Nordestgaard, Børge G.

AU - O'Donnell, Christopher

AU - Palmieri, Luigi

AU - Patel, Anushka

AU - Perel, Pablo

AU - Price, Jackie F.

AU - Providencia, Rui

AU - Ridker, Paul M.

AU - Rodriguez, Beatriz

AU - Rosengren, Annika

AU - Roussel, Ronan

AU - Sakurai, Masaru

AU - Salomaa, Veikko

AU - Sato, Shinichi

AU - Schöttker, Ben

AU - Shara, Nawar

AU - Shaw, Jonathan E.

AU - Shin, Hee Choon

AU - Simons, Leon A.

AU - Sofianopoulou, Eleni

AU - Sundström, Johan

AU - Völzke, Henry

AU - Wallace, Robert B.

AU - Wareham, Nicholas J.

AU - Willeit, Peter

AU - Wood, David

AU - Wood, Angela

AU - Zhao, Dong

AU - Woodward, Mark

AU - Danaei, Goodarz

AU - Roth, Gregory

AU - Mendis, Shanthi

AU - Onuma, Oyere

AU - Varghese, Cherian

AU - Ezzati, Majid

AU - Graham, Ian

AU - Jackson, Rod

AU - Danesh, John

AU - Di Angelantonio, Emanuele

PY - 2019/10

Y1 - 2019/10

N2 - 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. Funding: World Health Organization, British Heart Foundation (BHF), BHF Cambridge Centre for Research Excellence, UK Medical Research Council, and National Institute for Health Research.

AB - 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. Funding: World Health Organization, British Heart Foundation (BHF), BHF Cambridge Centre for Research Excellence, UK Medical Research Council, and National Institute for Health Research.

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