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


METHODS
A prospective cohort study within a national insurance system.


METHODS
18 health promotion centres nationwide between 1996 and 2001 in Korea.


METHODS
268 315 Koreans between the ages of 30 and 74 years without CHD at baseline.


METHODS
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.
Department of Epidemiology and Health Promotion, and Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
Sun Ha
SH
Jee
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea.
Yangsoo
Y
Jang
Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea.
Dong Joo
DJ
Oh
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Byung-Hee
BH
Oh
Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Sang Hoon
SH
Lee
Division of Cardiology, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Seong-Wook
SW
Park
Department of Internal Medicine, The Catholic University of Korea, School of Medicine, Seoul, Republic of Korea.
Ki-Bae
KB
Seung
Department of Epidemiology and Health Promotion, and Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
Yejin
Y
Mok
Department of Epidemiology and Health Promotion, and Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
Keum Ji
KJ
Jung
Department of Epidemiology and Health Promotion, and Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
Heejin
H
Kimm
Health Insurance Policy Research Institute, National Health Insurance Service, Seoul, Republic of Korea.
Young Duk
YD
Yun
Health Insurance Policy Research Institute, National Health Insurance Service, Seoul, Republic of Korea.
Soo Jin
SJ
Baek
Department of Family Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Duk Chul
DC
Lee
Seoul National University College of Medicine, Bundang Hospital, Sungnam, Republic of Korea.
Sung Hee
SH
Choi
Department of Family Medicine, CHA Bundang Medical Center, CHA University, Sungnam, Republic of Korea.
Moon Jong
MJ
Kim
Division of Cardiology, Department of Internal Medicine, Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Jidong
J
Sung
Department of Family Medicine, Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea.
BeLong
B
Cho
Department of Family Medicine, Daejeon Sun General Hospital, Daejeon, Republic of Korea.
Eung Soo
ES
Kim
Department of Family Medicine, Konyang University Hospital, Daejeon, Republic of Korea.
Byung-Yeon
BY
Yu
Department of Preventive Medicine and Public Health, College of Medicine, Chungnam National University, Daejeon, Republic of Korea.
Tae-Yong
TY
Lee
Department of Family Medicine, School of Medicine, Chungnam National University, Daejeon, Republic of Korea.
Jong Sung
JS
Kim
Department of Occupational and Environmental Medicine, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea.
Yong-Jin
YJ
Lee
Department of Occupational and Environmental Medicine, Daejeon Eulji University Hospital, Daejeon, Republic of Korea.
Jang-Kyun
JK
Oh
Department of Family Medicine, Daegu Catholic University Hospital, Daegu, Republic of Korea.
Sung Hi
SH
Kim
Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
Jong-Ku
JK
Park
Institute of Genomic Cohort, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
Sang Baek
SB
Koh
Department of Family Practice and Community Health, Ajou University School of Medicine, Suwon, Republic of Korea.
Sat Byul
SB
Park
Department of Preventive Medicine, Ajou University School of Medicine, Suwon, Republic of Korea.
Soon Young
SY
Lee
Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
Cheol-In
CI
Yoo
Department of Family Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
Moon Chan
MC
Kim
The Health Screening and Promotion Center, Asan Medical Center, Seoul, Republic of Korea.
Hong-Kyu
HK
Kim
Department of Family Medicine, Dong-A University Medical Center, Busan, Republic of Korea.
Joo-Sung
JS
Park
Department of Preventive Medicine and Public Health, Yonsei University College of Medicine, Seoul, Republic of Korea.
Hyeon Chang
HC
Kim
Korea Medical Institute, Seoul, Republic of Korea.
Gyu Jang
GJ
Lee
Nuffield Department of Population Health, The George Institute for Global Health, University of Oxford, Oxford, UK The George Institute for Global Health, University of Sydney, Sydney, Australia Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Mark
M
Woodward
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D011446:Prospective Studies; D056910:Republic of Korea; D018570:Risk Assessment
Epidemiology