Derivation, internal validation, and recalibration of a cardiovascular risk score for Latin America and the Caribbean (Globorisk-LAC): A pooled analysis of cohort studies

 

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Autores: Cohorts Consortium of Latin America and the Caribbean (CC-LAC), Carrillo Larco, Rodrigo Martín, Miranda Montero, Juan Jaime, Ezzati, Majid, Danaei, Goodarz, Stern, Dalia, Hambleton, Ian R., Lotufo, Paulo Andrade, Di Cesare, Mariachiara, Hennis, Anselm, Ferreccio, Catterina, Irazola, Vilma, Perel, Pablo, Gregg, Edward W., Aguilar Salinas, Carlos Alberto, Álvarez Vaz, Ramón, Amadio, Marselle Bevilacqua, Baccino, Cecilia, Bambs S., Claudia, Bastos, João Luiz Dornelles, Beckles, Gloria, Bernabé Ortiz, Antonio, Bernardo, Carla, Bloch, Katia Vergetti, Blümel, Juan Enrique, Boggia, José G., Borges, Pollyana Kássia de Oliveira, Bravo, Miguel, Brenes Camacho, Gilbert, Carbajal, Horacio A., Casas Vásquez, Paola, Castillo Rascón, María Susana, Ceballos, Blanca H., Colpani, Verônica, Cooper, Jackie A., Cortés, Sandra, Cortés Valencia, Adrián, de Sá Cunha, Roberto, d'Orsi, Eleonora, Dow, William H., Espeche, Walter G., Fuchs, Flavio Danni, Pereira Costa Fuchs, Sandra Cristina, Godoy Agostinho Gimeno, Suely, Gómez Velasco, Donaji Verónica, González Chica, David Alejandro, González Villalpando, Clicerio, González Villalpando, María Elena, Grazioli, Gonzalo, Guerra, Ricardo Oliveira, Gutierrez, Laura E., Herkenhoff Vieira, Fernando Luiz, Horimoto, Andrea Roseli Vancan Russo, Huidobro Muñoz, Laura Andrea, Koch, Elard S., Lajous Loaeza, Martin, Furtado de Lima e Costa, Maria Fernanda, López Ridaura, Ruy, Campos Cavalcanti Maciel, Álvaro, Maestre, Gladys Elena, Manrique Espinoza, Betty Soledad, Marques, Larissa Pruner, Melgarejo Arias, Jesus David, Mena Camaré, Luis Javier, Mill, Jose Gerardo, Moreira, Leila Beltrami, Muñoz Velandia, Oscar Mauricio, Ono, Lariane Mortean, Oppermann, Karen, Ortiz Saavedra, Pedro José, de Paiva, Karina Mary, Viana Peixoto, Sérgio William, da Costa Pereira, Alexandre, Peres, Karen G., de Anselmo Peres, Marco Aurelio, Ramírez Palacios, Paula, Rech, Cassiano Ricardo, Rivera Paredez, Berenice, Rodríguez Guerrero, Nohora Inés, Rojas Martínez, Maria Rosalba, Rosero Bixby, Luis, Rubinstein, Adolfo, Ruiz Morales, Álvaro de Jesus, Salazar, Martin R., Salinas Rodríguez, Aarón, Nájera Salmerón, Jorge Alberto, Sánchez, Ramón Augusto, de Souza e Silva, Nelson Albuquerque, Nogueira da Silva, Thiago Luiz, Smeeth, Liam, Spritzer, Poli Mara, Tartaglione, Fiorella, Tartaglione, Jorge, Tello Rodríguez, Tania, Velázquez Cruz, Rafael
Formato: artículo original
Fecha de Publicación:2022
Descripción:Background: Risk stratification is a cornerstone of cardiovascular disease (CVD) prevention and a main strategy proposed to achieve global goals of reducing premature CVD deaths. There are no cardiovascular risk scores based on data from Latin America and the Caribbean (LAC) and it is unknown how well risk scores based on European and North American cohorts represent true risk among LAC populations. Methods: We developed a CVD (including coronary heart disease and stroke) risk score for fatal/non-fatal events using pooled data from 9 prospective cohorts with 21,378 participants and 1,202 events. We developed laboratory based (systolic blood pressure, total cholesterol, diabetes, and smoking), and office-based (body mass index replaced total cholesterol and diabetes) models. We used Cox proportional hazards and held back a subset of participants to internally validate our models by estimating Harrell’s C-statistic and calibration slopes. Findings: The C-statistic for the laboratory-based model was 72% (70−74%), the calibration slope was 0.994 (0.934−1.055) among men and 0.852 (0.761−0.942) among women; for the office-based model the C-statistic was 71% (69−72%) and the calibration slope was 1.028 (0.980−1.076) among men and 0.811 (0.663−0.958) among women. In the pooled sample, using a 20% risk threshold, the laboratory-based model had sensitivity of 21.9% and specificity of 94.2%. Lowering the threshold to 10% increased sensitivity to 52.3% and reduced specificity to 78.7%. Interpretation: The cardiovascular risk score herein developed had adequate discrimination and calibration. The Globorisk-LAC would be more appropriate for LAC than the current global or regional risk scores. This work provides a tool to strengthen risk-based cardiovascular prevention in LAC.
País:Kérwá
Institución:Universidad de Costa Rica
Repositorio:Kérwá
Lenguaje:Inglés
OAI Identifier:oai:kerwa.ucr.ac.cr:10669/91596
Acceso en línea:https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(22)00075-8/fulltext
https://hdl.handle.net/10669/91596
Palabra clave:Risk prediction
Primary prevention
Cardiovascular diseases
Global health
LATIN AMERICA
Latin America and the Caribbean
predicción de riesgo
prevención primaria
salud global

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