BMJ Open. 2014 May 21;4(5):e005025. doi: 10.1136/bmjopen-2014-005025.

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

Jee SH1, Jang Y2, Oh DJ3, Oh BH4, Lee SH5, Park SW6, Seung KB7, Mok Y1, Jung KJ1, Kimm H1, Yun YD8, Baek SJ8, Lee DC9, Choi SH10, Kim MJ11, Sung J12, Cho B13, Kim ES14, Yu BY15, Lee TY16, Kim JS17, Lee YJ18, Oh JK19, Kim SH20, Park JK21, Koh SB22, Park SB23, Lee SY24, Yoo CI25, Kim MC26, Kim HK27, Park JS28, Kim HC29, Lee GJ30, Woodward M31.

Abstract

OBJECTIVE:

The objectives of this study were to develop a coronary heart disease (CHD) risk model among theKorean 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 CHDmodel, 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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