Prediction of mortality from coronary heart disease among diverse populations: Is there a common predictive function?

Youlian Liao, Victor Hawthorne, Djordje Kozarevic, Nikola Vojvodic, Charles Gillis, Victor Hawthorne, David Hole, Carole Hart, Torben Jorgensen, Troels Thomsen, Randi Selmer, Aage Tverdal, Emil Sigurdsson, Uri Goldbourt, Shlomit Yaari, Paul Froom, Shuguang Lin, Yihe Li, Xiaoqing Liu, Dan LacklandCurtis Hames, Peter Gazes, Julian Keil, Dan Lackland, Susan Sutherland, Zhaohai Li, Richard Cooper, Ronan Conroy, Christopher Sempos, Janet Bean, Guichan Cao, Christopher Khedouri, Ramon Durazo-Arvizu, Daniel Lackland, Youlian Liao, Stuart Lipsitz, Daniel McGee, Sundar Natarajan, Debjyoti Sinha, Barbara Tilley

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: To examine the generalisability of multivariate risk functions from diverse populations in three contexts: ordering risk, magnitude of relative risks, and estimation of absolute risk. Design: Meta-analysis of prospective cohort studies. Patients: Participants from various epidemiological studies. Main outcome measure: Death from coronary heart disease (CHD). Results: The analysis included 105 420 men and 56 535 women 35-74 years of age and free of CHD at baseline from 16 observational studies with a total of 27 analytical groups. The area under the receiver operating characteristic curve (AUC) was used to judge the ability of the multivariate risk function to order risk correctly. AUCs ranged from 0.60 to 0.80. The AUCs differed significantly between the studies (p < 0.01) but were very similar for different risk functions applied to the same population, indicating similar ability to rank risk for different models. The magnitudes of the relative risks associated with major risk factors (age, systolic blood pressure, serum total cholesterol, smoking, and diabetes) varied significantly across studies (p < 0.05 for homogeneity). The prediction of absolute risk was not very accurate in most of the cases when a model derived from one study was applied to a different study. Conclusions: When considered qualitatively, the major risk factors are associated with CHD mortality in a diverse set of populations. However, when considered quantitatively, there was significant heterogeneity in all three aspects: ordering risk, magnitude of relative risks, and estimation of absolute risk.

Original languageEnglish
Pages (from-to)222-228
Number of pages7
JournalHeart
Volume88
Issue number3
StatePublished - Sep 2002

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