A coronary heart disease prediction model: the Korean Heart Study.

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.