Prediction of cardiovascular risk: validation of a non-laboratory and a laboratory-based score in a Brazilian community-based cohort of the PURE studyResearch in context
Summary: Background: Risk scores are essential tools for implementing cardiovascular disease (CVD) prevention. Validating risk scores considering regional diversities and disparities is critical for reducing the burden of CVD on global morbidity and mortality. We aimed to validate two cardiovascula...
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Elsevier
2025-03-01
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| Series: | The Lancet Regional Health. Americas |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667193X25000195 |
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| author | Gustavo Bernardes de Figueiredo Oliveira Rafael Amorim Belo Nunes Lucas Bassolli de Oliveira Alves Precil Diego Miranda de Menezes Neves Victor Augusto Hamamoto Sato Ana Heloisa Kamada Triboni Haliton Alves de Oliveira Júnior Priscila Raupp da Rosa Maria Luz Díaz Jose Patricio Lopez-Jaramillo Fernando Lanas Philip Joseph Álvaro Avezum |
| author_facet | Gustavo Bernardes de Figueiredo Oliveira Rafael Amorim Belo Nunes Lucas Bassolli de Oliveira Alves Precil Diego Miranda de Menezes Neves Victor Augusto Hamamoto Sato Ana Heloisa Kamada Triboni Haliton Alves de Oliveira Júnior Priscila Raupp da Rosa Maria Luz Díaz Jose Patricio Lopez-Jaramillo Fernando Lanas Philip Joseph Álvaro Avezum |
| author_sort | Gustavo Bernardes de Figueiredo Oliveira |
| collection | DOAJ |
| description | Summary: Background: Risk scores are essential tools for implementing cardiovascular disease (CVD) prevention. Validating risk scores considering regional diversities and disparities is critical for reducing the burden of CVD on global morbidity and mortality. We aimed to validate two cardiovascular risk scores (laboratory and non-laboratory-based) to predict major adverse cardiovascular events in the Brazilian cohort of the PURE study. Methods: We validated two risk scores derived from the INTERHEART study, the non-laboratory INTERHEART risk score (NL-IHRS) and the laboratory fasting cholesterol INTERHEART risk score (FC-IHRS) using data from 4623 (urban areas) and 1415 (rural areas) participants without CVD in the Brazilian cohort of the PURE study enrolled in 2004 and 2005 and followed up to September 2021. The endpoint was major cardiovascular events (MACE), defined as the composite of myocardial infarction, stroke, heart failure, or death from cardiovascular causes. We evaluated the model performance of IHRS through c-statistic and calibration methods. Findings: After a mean follow-up of 8.8 years (range, 0.28–15.1 years), there were 312 cardiovascular events, corresponding to an incidence rate of 0.58% per year (0.56% per year in urban versus 0.64% per year in rural areas). For the NL-IHRS, the c-statistic was 0.69 (95% confidence interval, CI, 0.66–0.72) in the overall cohort, 0.68 (95% CI, 0.64–0.72) in the urban cohort, and 0.72 (95% CI, 0.66–0.78) in the rural cohort. C-statistic values for the recalibrated FC-IHRS were 0.71 (95% CI, 0.67–0.74), 0.71 (95% CI, 0.67–0.75), and 0.70 (95% CI, 0.64–0.76) in the overall, urban, and rural cohorts, respectively. Interpretation: In this Brazilian community-based prospective cohort, both NL-IHRS and FC-IHRS-based models performed with reasonable discriminative accuracy on the risk estimation of long-term risk of major CVD. A non-laboratory-based CVD risk score may be instrumental in Brazilian communities with limited access to medical resources. Funding: Population Health Research Institute, Novartis Biociências S.A. |
| format | Article |
| id | doaj-art-d7a446456a4943fd8fc394fa6cdf5266 |
| institution | OA Journals |
| issn | 2667-193X |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Americas |
| spelling | doaj-art-d7a446456a4943fd8fc394fa6cdf52662025-08-20T02:13:48ZengElsevierThe Lancet Regional Health. Americas2667-193X2025-03-014310100910.1016/j.lana.2025.101009Prediction of cardiovascular risk: validation of a non-laboratory and a laboratory-based score in a Brazilian community-based cohort of the PURE studyResearch in contextGustavo Bernardes de Figueiredo Oliveira0Rafael Amorim Belo Nunes1Lucas Bassolli de Oliveira Alves2Precil Diego Miranda de Menezes Neves3Victor Augusto Hamamoto Sato4Ana Heloisa Kamada Triboni5Haliton Alves de Oliveira Júnior6Priscila Raupp da Rosa7Maria Luz Díaz8Jose Patricio Lopez-Jaramillo9Fernando Lanas10Philip Joseph11Álvaro Avezum12International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, BrazilInternational Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, BrazilInternational Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, BrazilInternational Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, BrazilInternational Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, BrazilInternational Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, BrazilInternational Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, BrazilNovartis Biociências S.A, São Paulo, BrazilInstituto Cardiovascular de Rosario, Rosario, ArgentinaMasira Research Institute, Medical School, Universidad de Santander, Bucaramanga, ColombiaUniversidad de la Frontera, Temuco, ChilePopulation Health Research Institute, McMaster University, Hamilton, CanadaInternational Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Population Health Research Institute, McMaster University, Hamilton, Canada; Corresponding author. International Research Center, Hospital Alemão Oswaldo Cruz, Av. Paulista, 500, 5º andar, São Paulo, SP 01310-000, Brazil.Summary: Background: Risk scores are essential tools for implementing cardiovascular disease (CVD) prevention. Validating risk scores considering regional diversities and disparities is critical for reducing the burden of CVD on global morbidity and mortality. We aimed to validate two cardiovascular risk scores (laboratory and non-laboratory-based) to predict major adverse cardiovascular events in the Brazilian cohort of the PURE study. Methods: We validated two risk scores derived from the INTERHEART study, the non-laboratory INTERHEART risk score (NL-IHRS) and the laboratory fasting cholesterol INTERHEART risk score (FC-IHRS) using data from 4623 (urban areas) and 1415 (rural areas) participants without CVD in the Brazilian cohort of the PURE study enrolled in 2004 and 2005 and followed up to September 2021. The endpoint was major cardiovascular events (MACE), defined as the composite of myocardial infarction, stroke, heart failure, or death from cardiovascular causes. We evaluated the model performance of IHRS through c-statistic and calibration methods. Findings: After a mean follow-up of 8.8 years (range, 0.28–15.1 years), there were 312 cardiovascular events, corresponding to an incidence rate of 0.58% per year (0.56% per year in urban versus 0.64% per year in rural areas). For the NL-IHRS, the c-statistic was 0.69 (95% confidence interval, CI, 0.66–0.72) in the overall cohort, 0.68 (95% CI, 0.64–0.72) in the urban cohort, and 0.72 (95% CI, 0.66–0.78) in the rural cohort. C-statistic values for the recalibrated FC-IHRS were 0.71 (95% CI, 0.67–0.74), 0.71 (95% CI, 0.67–0.75), and 0.70 (95% CI, 0.64–0.76) in the overall, urban, and rural cohorts, respectively. Interpretation: In this Brazilian community-based prospective cohort, both NL-IHRS and FC-IHRS-based models performed with reasonable discriminative accuracy on the risk estimation of long-term risk of major CVD. A non-laboratory-based CVD risk score may be instrumental in Brazilian communities with limited access to medical resources. Funding: Population Health Research Institute, Novartis Biociências S.A.http://www.sciencedirect.com/science/article/pii/S2667193X25000195Cardiovascular diseaseRisk scoreRisk factorsBrazilValidation study |
| spellingShingle | Gustavo Bernardes de Figueiredo Oliveira Rafael Amorim Belo Nunes Lucas Bassolli de Oliveira Alves Precil Diego Miranda de Menezes Neves Victor Augusto Hamamoto Sato Ana Heloisa Kamada Triboni Haliton Alves de Oliveira Júnior Priscila Raupp da Rosa Maria Luz Díaz Jose Patricio Lopez-Jaramillo Fernando Lanas Philip Joseph Álvaro Avezum Prediction of cardiovascular risk: validation of a non-laboratory and a laboratory-based score in a Brazilian community-based cohort of the PURE studyResearch in context The Lancet Regional Health. Americas Cardiovascular disease Risk score Risk factors Brazil Validation study |
| title | Prediction of cardiovascular risk: validation of a non-laboratory and a laboratory-based score in a Brazilian community-based cohort of the PURE studyResearch in context |
| title_full | Prediction of cardiovascular risk: validation of a non-laboratory and a laboratory-based score in a Brazilian community-based cohort of the PURE studyResearch in context |
| title_fullStr | Prediction of cardiovascular risk: validation of a non-laboratory and a laboratory-based score in a Brazilian community-based cohort of the PURE studyResearch in context |
| title_full_unstemmed | Prediction of cardiovascular risk: validation of a non-laboratory and a laboratory-based score in a Brazilian community-based cohort of the PURE studyResearch in context |
| title_short | Prediction of cardiovascular risk: validation of a non-laboratory and a laboratory-based score in a Brazilian community-based cohort of the PURE studyResearch in context |
| title_sort | prediction of cardiovascular risk validation of a non laboratory and a laboratory based score in a brazilian community based cohort of the pure studyresearch in context |
| topic | Cardiovascular disease Risk score Risk factors Brazil Validation study |
| url | http://www.sciencedirect.com/science/article/pii/S2667193X25000195 |
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