Predicting the 10-Year Risks of Atherosclerotic Cardiovascular Disease in Chinese Population: The China-PAR Project (Prediction for ASCVD Risk in China).
BACKGROUND
The accurate assessment of individual risk can be of great value to guiding and facilitating the prevention of atherosclerotic cardiovascular disease (ASCVD). However, prediction models in common use were formulated primarily in white populations. The China-PAR project (Prediction for ASCVD Risk in China) is aimed at developing and validating 10-year risk prediction equations for ASCVD from 4 contemporary Chinese cohorts.


METHODS
Two prospective studies followed up together with a unified protocol were used as the derivation cohort to develop 10-year ASCVD risk equations in 21 320 Chinese participants. The external validation was evaluated in 2 independent Chinese cohorts with 14 123 and 70 838 participants. Furthermore, model performance was compared with the Pooled Cohort Equations reported in the American College of Cardiology/American Heart Association guideline.


RESULTS
Over 12 years of follow-up in the derivation cohort with 21 320 Chinese participants, 1048 subjects developed a first ASCVD event. Sex-specific equations had C statistics of 0.794 (95% confidence interval, 0.775-0.814) for men and 0.811 (95% confidence interval, 0.787-0.835) for women. The predicted rates were similar to the observed rates, as indicated by a calibration χ2of 13.1 for men (P=0.16) and 12.8 for women (P=0.17). Good internal and external validations of our equations were achieved in subsequent analyses. Compared with the Chinese equations, the Pooled Cohort Equations had lower C statistics and much higher calibration χ2values in men.


CONCLUSIONS
Our project developed effective tools with good performance for 10-year ASCVD risk prediction among a Chinese population that will help to improve the primary prevention and management of cardiovascular disease.
From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China.
Xueli
X
Yang
From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China.
Jianxin
J
Li
From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China.
Dongsheng
D
Hu
From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China.
Jichun
J
Chen
From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China.
Ying
Y
Li
From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China.
Jianfeng
J
Huang
From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China.
Xiaoqing
X
Liu
From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China.
Fangchao
F
Liu
From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China.
Jie
J
Cao
From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China.
Chong
C
Shen
From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China.
Ling
L
Yu
From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China.
Fanghong
F
Lu
From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China.
Xianping
X
Wu
From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China.
Liancheng
L
Zhao
From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China.
Xigui
X
Wu
From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China. gudf@yahoo.com.
Dongfeng
D
Gu
D000328:Adult; D000368:Aged; D044466:Asian People; D050197:Atherosclerosis / Q000453:epidemiology* / Q000517:prevention & control; D002681:China / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors
assessment; atherosclerosis; cardiovascular diseases; risk; risk factors