机构：[1]Department of Public Health and Primary Care,University of Cambridge, Cambridge, UK[2]MRC Epidemiology Unit,University of Cambridge School of Clinical Medicine,University of Cambridge, Cambridge, UK[3]Department of Public Health and Primary Care, Ghent University, Ghent, Belgium[4]St Vincent’s University Hospital and School of Medicine, University College Dublin, Dublin, Ireland[5]Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands[6]World Health Organization, Geneva, Switzerland[7]Department of Cardiology, Trakya University School of Medicine, Edirne, Turkey[8]Institut Pasteur de Lille, Lille, France[9]Assmann-Stiftung für Prävention, Münster, Germany[10]Population Health Sciences, Bristol University, Bristol, UK[11]Harvard T H Chan School of Public Health[12]Brigham & Women’s Hospital, Harvard Medical School,Harvard University, Boston,MA, USA[13]Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University Medical Center,Amsterdam, Netherlands[14]Department of Public Health and Community Medicine, Primary Health Care, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden[15]Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital[16]Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA[17]Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA[18]University of Auckland, Auckland, New Zealand[19]Division of Clinical Epidemiology and Ageing Research,German Cancer Research Center, Heidelberg, Germany[20]Division of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany[21]Network Aging Research, University of Heidelberg, Heidelberg, Germany[22]Department of Epidemiology and Public Health, University College London, London, UK[23]BHF Laboratories,University College London, London, UK[24]Institute of Health Informatics,University College London, London, UK[25]Department of Medicine, University of Padua, Padua, Italy[26]Cardio-Metabolic Research Group, Department of Social Medicine, Sanpasitthiprasong Hospital, Ubon Ratchathani, Thailand[27]Division of Cardiovascular Sciences, National Heart,Lung, and Blood Institute, Bethesda, MD, USA[28]School of Community Health, Portland State University, Portland, OR, USA[29]Department of Medicine, University of Vermont,Colchester, VT, USA[30]Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec,QC, Canada[31]Mathematics and Statistics Department,Boston University, Boston, MA, USA[32]Global Center of Excellence Program Study Group, Yamagata University Faculty of Medicine, Yamagata, Japan[33]Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Aomori, Japan[34]Department of Medicine,Columbia University Irving Medical Center, New York, NY, USA[35]Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden[36]Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China循证医学中心[37]Institute of Health & Wellbeing, University of Glasgow,Glasgow, UK[38]Department of Psychiatry, Warneford Hospital,University of Oxford, Oxford, UK[39]George Institute for Global Health,University of Oxford, Oxford, UK[40]Department of Internal Medicine，University Medical Centre Groningen, University of Groningen, Groningen, Netherlands[41]Department of Epidemiology，University Medical Centre Groningen, University of Groningen, Groningen, Netherlands[42]Department of Cardiovascular, Dysmetabolic and Aging-associated Diseases, Istituto Superiore di Sanità, Rome,Italy[43]School of Public Health, University of Minnesota, Minneapolis, MN, USA[44]Department of Community Medicine, Arctic University of Norway, Tromso, Norway[45]Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht,Utrecht, Netherlands[46]Faculty of Medicine, University of Iceland, Reykjavik, Iceland[47]The Icelandic Heart Association, Kopavogur, Iceland[48]Osaka University Graduate School of Medicine, Suita, Japan[49]Department of Cardiology, Leiden University Medical Center, Leiden,Netherlands[50]Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland[51]Non Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa[52]Prevention of Metabolic Disorder Research Center,Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran[53]School of Population and Global Health, University of Western Australia, Perth, WA, Australia[54]Deutsches Herzzentrum München, Technische Universität München, Munich, Germany[55]German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany[56]Yale School of Medicine, Yale University, New Haven, CT, USA[57]School of Public Health, University of Hong Kong, Hong Kong, China[58]Family Medicine & Public Health, University of California, San Diego,CA, USA[59]San Jose Norte Health Centre, Zaragoza, Spain[60]Medical University of South Carolina, Charleston, SC, USA[61]Department of Epidemiology and Public Health,Graduate School of Medical Sciences, Kyushu University, Fukuoka,Japan[62]Faculty of Health and Medical Sciences,University of Copenhagen, Copenhagen, Denmark[63]Boston Veteran’s Affairs Healthcare System,Boston, MA, USA[64]George Institute for Global Health,University of New South Wales, Sydney, NSW, Australia[65]Faculty of Medicine,University of New South Wales, Sydney, NSW, Australia[66]Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, UK[67]Molecular Epidemiology Research Group, Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh,Edinburgh, UK[68]Department of Geriatric Medicine,University of Hawaii and Tecnologico de Monterrey, Honolulu, HI,USA[69]Sahlgrenska University Hospital and Östra Hospital, Göteborg, Sweden[70]INSERM, UMRS 1138,Centre de Recherche des Cordeliers, Université Paris Diderot,Sorbonne Paris Cité, UFR de Médecine, and Assistance Publique Hôpitaux de Paris, Hôpital Bichat, Département HospitaloUniversitaire FIRE, Service de Diabétologie, Endocrinologie et Nutrition, Paris, France[71]Department of Social and Environmental Medicine, Kanazawa Medical University, Uchinada,Japan[72]National Institute for Health and Welfare, Helsinki,Finland[73]Chiba Prefectural Institute of Public Health,Chiba, Japan[74]Department of Biostatistics and Bioinformatics,MedStar Health Research Institute, Hyattsville, MD, USA[75]Baker Heart and Diabetes Institute, Melbourne, VIC, Australia[76]US Centers for Disease Control and Prevention,Hyattsville, MD, USA[77]Department of Medical Sciences,Uppsala University, Uppsala, Sweden[78]Department of Public Health Solutions, National Institute for Health and Welfare,Helsinki, Finland[79]Shiga University of Medical Science,Shiga, Japan[80]Institute for Community Medicine,University Medicine Greifswald, University of Greifswald, Greifswald,Germany[81]German Centre for Cardiovascular Disease(DZHK), Partner Site Greifswald, and German Centre for Cardiovascular Disease (DZD), Site Greifswald, Greifswald, Germany[82]Department of Epidemiology, University of Iowa College of Public Health, IA, USA[83]Department of Neurology &Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria[84]National Heart & Lung Institute,Faculty of Medicine, Imperial College London, London, UK[85]School of Public Health,Faculty of Medicine, Imperial College London, London, UK[86]Beijing Institute of Heart, Lung & Blood Vessel Diseases, Capital Medical University Beijing Anzhen Hospital, Beijing,China[87]Department of Medicine, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA[88]Geneva Learning Foundation, Geneva, Switzerland[89]School of Medicine, Trinity College Dublin, University of Dublin, Dublin,Ireland[90]Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care,University of Cambridge,Cambridge CB1 8RN, UK
Background To help adapt cardiovascular disease risk prediction approaches to low-income and middle-income countries, WHO has convened an effort to develop, evaluate, and illustrate revised risk models. Here, we report the derivation, validation, and illustration of the revised WHO cardiovascular disease risk prediction charts that have been adapted to the circumstances of 21 global regions. Methods In this model revision initiative, we derived 10-year risk prediction models for fatal and non-fatal cardiovascular disease (ie, myocardial infarction and stroke) using individual participant data from the Emerging Risk Factors Collaboration. Models included information on age, smoking status, systolic blood pressure, history of diabetes, and total cholesterol. For derivation, we included participants aged 40-80 years without a known baseline history of cardiovascular disease, who were followed up until the first myocardial infarction, fatal coronary heart disease, or stroke event. We recalibrated models using age-specific and sex-specific incidences and risk factor values available from 21 global regions. For external validation, we analysed individual participant data from studies distinct from those used in model derivation. We illustrated models by analysing data on a further 123 743 individuals from surveys in 79 countries collected with the WHO STEPwise Approach to Surveillance. Findings Our risk model derivation involved 376 177 individuals from 85 cohorts, and 19 333 incident cardiovascular events recorded during 10 years of follow-up. The derived risk prediction models discriminated well in external validation cohorts (19 cohorts, 1 096 061 individuals, 25 950 cardiovascular disease events), with Harrell's C indices ranging from 0.685 (95% CI 0 . 629-0 741) to 0.833 (0 . 783-0- 882). For a given risk factor profile, we found substantial variation across global regions in the estimated 10-year predicted risk. For example, estimated cardiovascular disease risk for a 60-year-old male smoker without diabetes and with systolic blood pressure of 140 mm Hg and total cholesterol of 5 mmol/L ranged from 11% in Andean Latin America to 30% in central Asia. When applied to data from 79 countries (mostly low-income and middle-income countries), the proportion of individuals aged 40-64 years estimated to be at greater than 20% risk ranged from less than 1% in Uganda to more than 16% in Egypt. Interpretation We have derived, calibrated, and validated new WHO risk prediction models to estimate cardiovascular disease risk in 21 Global Burden of Disease regions. The widespread use of these models could enhance the accuracy, practicability, and sustainability of efforts to reduce the burden of cardiovascular disease worldwide. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.
第一作者机构：[1]Department of Public Health and Primary Care,University of Cambridge, Cambridge, UK
通讯作者：
通讯机构：[1]Department of Public Health and Primary Care,University of Cambridge, Cambridge, UK
推荐引用方式(GB/T 7714)：
Stephen Kaptoge,Di Angelantonio Emanuele,Lisa Pennells,et al.World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions[J].LANCET GLOBAL HEALTH.2019,7(10):E1332-E1345.doi:10.1016/S2214-109X(19)30318-3.
APA：
Stephen Kaptoge,Di Angelantonio, Emanuele,Lisa Pennells,Dirk De Bacquer,Marie Therese Cooney...&Emanuele Di Angelantonio.(2019).World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions.LANCET GLOBAL HEALTH,7,(10)
MLA：
Stephen Kaptoge,et al."World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions".LANCET GLOBAL HEALTH 7..10(2019):E1332-E1345
医学