title: Estimating modifiable coronary heart disease risk in multiple regions of the world: the INTERHEART Modifiable Risk Score.
abstract: OBJECTIVE
  Summating risk factor burden is a useful approach in the assessment of cardiovascular risk among apparently healthy individuals. We aimed to derive and validate a new score for myocardial infarction (MI) risk using modifiable risk factors, derived from the INTERHEART case-control study (n = 19 470).
  
  
  RESULTS
  Multiple logistic regression was used to create the INTERHEART Modifiable Risk Score (IHMRS). Internal validation was performed using split-sample methods. External validation was performed in an international prospective cohort study. A risk model including apolipoproteins, smoking, second-hand smoke exposure, hypertension, and diabetes was developed. Addition of further modifiable risk factors did not improve score discrimination in an external cohort. Split-sample validation studies showed an area under the receiver-operating characteristic (ROC) curve c-statistic of 0.71 [95% confidence interval (CI): 0.70, 0.72]. The IHMRS was positively associated with incident MI in a large cohort of people at low risk for cardiovascular disease [12% increase in MI risk (95% CI: 8, 16%) with a 1-point increase in score] and showed appropriate discrimination in this cohort (ROC c-statistic 0.69, 95% CI: 0.64, 0.74). Results were consistent across ethnic groups and geographic regions. A non-laboratory-based score is also supplied.
  
  
  CONCLUSIONS
  Using multiple modifiable risk factors from the INTERHEART case-control study, we have developed and validated a simple score for MI risk which is applicable to an international population.
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences, McMaster University, David Braley Cardiovascular Stroke Research Institute, Hamilton, ON, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: McGorrian
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
authors.forename: Shofiqul
authors.initials: S
authors.lastname: Islam
authors.forename: Hyejung
authors.initials: H
authors.lastname: Jung
authors.forename: Sumathy
authors.initials: S
authors.lastname: Rangarajan
authors.forename: Alvaro
authors.initials: A
authors.lastname: Avezum
authors.forename: Dorairaj
authors.initials: D
authors.lastname: Prabhakaran
authors.forename: Wael
authors.initials: W
authors.lastname: Almahmeed
authors.forename: Zvonko
authors.initials: Z
authors.lastname: Rumboldt
authors.forename: Andrzej
authors.initials: A
authors.lastname: Budaj
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Dans
authors.forename: Hertzel C
authors.initials: HC
authors.lastname: Gerstein
authors.forename: Koon
authors.initials: K
authors.lastname: Teo
authors.forename: Sonia S
authors.initials: SS
authors.lastname: Anand
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003327:Coronary Disease / Q000453:epidemiology*; D005260:Female; D014943:Global Health / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D012111:Residence Characteristics; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors