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JAMA, vol.291, no.21, 2591~2599, June, 2004. Presented by 陳桂弦 2004.7.20

Predictive Value for the Chinese Population of the Framingham CHD Risk Assessment Tool Compared With the Chinese Multi-provincial Cohort Study. JAMA, vol.291, no.21, 2591~2599, June, 2004. Presented by 陳桂弦 2004.7.20. Introduction.

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JAMA, vol.291, no.21, 2591~2599, June, 2004. Presented by 陳桂弦 2004.7.20

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  1. Predictive Value for the Chinese Population of the Framingham CHD Risk Assessment Tool Compared With the Chinese Multi-provincial Cohort Study JAMA, vol.291, no.21, 2591~2599, June, 2004. Presented by 陳桂弦 2004.7.20

  2. Introduction • The Framingham heart study has contributed to the identification of risk factors for CHD. • It has developed multivariable functions to predict absolute CHD risk.

  3. Objective • To evaluate the performance of the Framingham CHD risk functions, directly and after recalibration, in a large Chinese population, compared with the performance of the functions derived from the Chinese Multi-provincial Cohort Study (CMCS).

  4. Method

  5. Participants • Chinese Multi-provincial Cohort Study(CMCS) cohort: • 30121 Chinese adults aged 35 to 64 years at baseline. • Participants were recruited from 16centers in 11 provinces and were followed up for new CHD events from 1992 to 2002.

  6. Participants • Framingham Heart Study cohort: • participants were 5251 white US residents from the original and offspring cohort of Framingham Heart Study. • 30 to 74 years old at baseline in 1971 to 1974 • followed up for 12 years.

  7. Risk Factor Measurement(CMCS cohort) • Age • Blood Pressure • Hypertension was categorized according to JNC-V • Total Cholesterol • HDL-C • ATP-III • Diabetes • fasting glucose >=140 mg/dL or clinical history • Smoking • Current smokers categorical binary

  8. End point • “Hard” CHD events, comprising acute myocardial infarction, sudden death, and other coronary deaths, were recorded.

  9. Statistical Analysis(1) • For each risk factor, the regression coefficients for the CMCS and Framingham cohorts were compared using a 2-tailed z statistic. • The absolute 10-year risk of hard CHD was predicted with a Cox regression model developed by Framingham investigators.

  10. Statistical Analysis(2) • The discriminatory power of a model was assessed by the area under the receiver operating characteristic curve (AUROC) • The predicted and actual risk in each decile were compared, and the difference was assessed by the Hosmer-Lemeshow X2 test.

  11. Results

  12. CHD Rates and Baseline Risk Factors • Hard CHD events: 191 • Total death: 625 • 10-yr CHD event rate for M: 1.5% • for F: 0.6% CMCS • Hard CHD events: 273 • Total death: 293 • 10-yr CHD event rate for M: 8.0% • for F: 2.8% Framingham

  13. Risk factor levels at the baseling examination of the 2 cohorts (Men)

  14. Risk factor levels at the baseling examination of the 2 cohorts (Women)

  15.  coefficients and RRs

  16. Predictive Capacities • CMCS Functions: • The  coefficients in the CMCS Cox model,mean values of the risk factors, and mean incidence rates in the CMCS cohort were used. • Original Framingham Functions: • The  coefficients in the Framingham Cox model,mean values of the risk factors, and mean incidence rates in the Framingham cohort were used. • Recalibrated Framingham Functions: • The  coefficients were taken fromFramingham Cox model, but mean values of the risk factors, and mean incidence rates in the CMCS cohort were used.

  17. CMCS Functions • AUROCs : • Men:0.736 (95% CI:0.696~0.776) • Women:0.759 (95% CI:0.699~0.818) • Hosmer-Lemeshow X2 test : • Men:12.6 (P=.13) • Women:14.2 (P=.08)

  18. Original Framingham Functions • AUROCs : • Men:0.705 (95% CI:0.665~0.746) • Women:0.742 (95% CI:0.686~0.798) • Hosmer-Lemeshow X2 test : • Men:645.9 (P<.001) • Women:147.6 (P<.001)

  19. Recalibration Framingham Functions • Hosmer-Lemeshow X2 test : • Men:31.5 (P<.001) • Women:16.9 (P=.03)

  20. Additional Analyses • Performance of the CMCS and recalibrated Framingham functions for urban vs rural men and women were all very similar. • Less exercise tended to BP、glucose levels and HDL-C (NS)

  21. Comment

  22. Framingham functions have overestimatedCHD risk in some populations. • Recalibration of the Framingham functions improved the estimates and demonstrated that the Framingham model is useful in the Chinese population.

  23. For regions that have no established cohort, recalibration using CHD rates andrisk factors may be an effective method to develop CHD risk prediction algorithmssuited for local practice.

  24. ~END~

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