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PARS risk charts: A 10-year study of risk assessment for cardiovascular diseases in Eastern Mediterranean Region.

Abstract This study was designed to develop a risk assessment chart for the clinical management and prevention of the risk of cardiovascular disease (CVD) in Iranian population, which is vital for developing national prevention programs. The Isfahan Cohort Study (ICS) is a population-based prospective study of 6504 Iranian adults ≥35 years old, followed-up for ten years, from 2001 to 2010. Behavioral and cardiometabolic risk factors were examined every five years, while biennial follow-ups for the occurrence of the events was performed by phone calls or by verbal autopsy. Among these participants, 5432 (2784 women, 51.3%) were CVD free at baseline examination and had at least one follow-up. Cox proportional hazard regression was used to predict the risk of ischemic CVD events, including sudden cardiac death due to unstable angina, myocardial infarction, and stroke. The model fit statistics such as area under the receiver-operating characteristic (AUROC), calibration chi-square and the overall bias were used to assess the model performance. We also tested the Framingham model for comparison. Seven hundred and five CVD events occurred during 49452.8 person-years of follow-up. The event probabilities were calculated and presented color-coded on each gender-specific PARS chart. The AUROC and Harrell's C indices were 0.74 (95% CI, 0.72-0.76) and 0.73, respectively. In the calibration, the Nam-D'Agostino χ2 was 10.82 (p = 0.29). The overall bias of the proposed model was 95.60%. PARS model was also internally validated using cross-validation. The Android app and the Web-based risk assessment tool were also developed as to have an impact on public health. In comparison, the refitted and recalibrated Framingham models, estimated the CVD incidence with the overall bias of 149.60% and 128.23% for men, and 222.70% and 176.07% for women, respectively. In conclusion, the PARS risk assessment chart is a simple, accurate, and well-calibrated tool for predicting a 10-year risk of CVD occurrence in Iranian population and can be used in an attempt to develop national guidelines for the CVD management.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title plos one
Publication Year Start




PMID- 29261727
OWN - NLM
STAT- In-Process
LR  - 20171222
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 12
IP  - 12
DP  - 2017
TI  - PARS risk charts: A 10-year study of risk assessment for cardiovascular diseases 
      in Eastern Mediterranean Region.
PG  - e0189389
LID - 10.1371/journal.pone.0189389 [doi]
AB  - This study was designed to develop a risk assessment chart for the clinical
      management and prevention of the risk of cardiovascular disease (CVD) in Iranian 
      population, which is vital for developing national prevention programs. The
      Isfahan Cohort Study (ICS) is a population-based prospective study of 6504
      Iranian adults >/=35 years old, followed-up for ten years, from 2001 to 2010.
      Behavioral and cardiometabolic risk factors were examined every five years, while
      biennial follow-ups for the occurrence of the events was performed by phone calls
      or by verbal autopsy. Among these participants, 5432 (2784 women, 51.3%) were CVD
      free at baseline examination and had at least one follow-up. Cox proportional
      hazard regression was used to predict the risk of ischemic CVD events, including 
      sudden cardiac death due to unstable angina, myocardial infarction, and stroke.
      The model fit statistics such as area under the receiver-operating characteristic
      (AUROC), calibration chi-square and the overall bias were used to assess the
      model performance. We also tested the Framingham model for comparison. Seven
      hundred and five CVD events occurred during 49452.8 person-years of follow-up.
      The event probabilities were calculated and presented color-coded on each
      gender-specific PARS chart. The AUROC and Harrell's C indices were 0.74 (95% CI, 
      0.72-0.76) and 0.73, respectively. In the calibration, the Nam-D'Agostino chi2
      was 10.82 (p = 0.29). The overall bias of the proposed model was 95.60%. PARS
      model was also internally validated using cross-validation. The Android app and
      the Web-based risk assessment tool were also developed as to have an impact on
      public health. In comparison, the refitted and recalibrated Framingham models,
      estimated the CVD incidence with the overall bias of 149.60% and 128.23% for men,
      and 222.70% and 176.07% for women, respectively. In conclusion, the PARS risk
      assessment chart is a simple, accurate, and well-calibrated tool for predicting a
      10-year risk of CVD occurrence in Iranian population and can be used in an
      attempt to develop national guidelines for the CVD management.
FAU - Sarrafzadegan, Nizal
AU  - Sarrafzadegan N
AD  - Isfahan Cardiovascular Research Center, Cardiovascular Research Institute,
      Isfahan University of Medical Sciences, Isfahan, Iran.
AD  - School of Population and Public Health, Faculty of Medicine, University of
      British Columbia, Vancouver, British Columbia, Canada.
FAU - Hassannejad, Razieh
AU  - Hassannejad R
AD  - Department of Epidemiology and Biostatistics, School of Public Health, Isfahan
      University of Medical Sciences, Isfahan, Iran.
FAU - Marateb, Hamid Reza
AU  - Marateb HR
AD  - Biomedical Engineering Department, Engineering Faculty, University of Isfahan,
      Isfahan, Iran.
AD  - Department of Automatic Control, Biomedical Engineering Research Center,
      Universitat Politecnica de Catalunya, BarcelonaTech (UPC), Barcelona, Spain.
FAU - Talaei, Mohammad
AU  - Talaei M
AD  - Isfahan Cardiovascular Research Center, Cardiovascular Research Institute,
      Isfahan University of Medical Sciences, Isfahan, Iran.
AD  - Saw Swee Hock School of Public Health, National University of Singapore,
      Singapore, Singapore.
FAU - Sadeghi, Masoumeh
AU  - Sadeghi M
AD  - Isfahan Cardiovascular Research Center, Cardiovascular Research Institute,
      Isfahan University of Medical Sciences, Isfahan, Iran.
FAU - Roohafza, Hamid Reza
AU  - Roohafza HR
AD  - Isfahan Cardiovascular Research Center, Cardiovascular Research Institute,
      Isfahan University of Medical Sciences, Isfahan, Iran.
FAU - Masoudkabir, Farzad
AU  - Masoudkabir F
AD  - Department of Cardiology, School of Medicine, Tehran Heart Center, Tehran
      University of Medical Sciences, Tehran, Iran.
AD  - Cardiac Primary Prevention Research Center, Tehran Heart Center, Tehran
      University of Medical Sciences, Tehran, Iran.
FAU - OveisGharan, Shahram
AU  - OveisGharan S
AD  - Department of Neurology, School of Medicine, Tehran University of Medical
      Sciences, Tehran, Iran.
AD  - Rush Alzheimer's disease Center; Rush University Medical Center, Chicago,
      Illinois, United States of America.
FAU - Mansourian, Marjan
AU  - Mansourian M
AUID- ORCID: http://orcid.org/0000-0002-7217-0282
AD  - Department of Epidemiology and Biostatistics, School of Public Health, Isfahan
      University of Medical Sciences, Isfahan, Iran.
FAU - Mohebian, Mohammad Reza
AU  - Mohebian MR
AD  - Biomedical Engineering Department, Engineering Faculty, University of Isfahan,
      Isfahan, Iran.
FAU - Mananas, Miquel Angel
AU  - Mananas MA
AD  - Department of Automatic Control, Biomedical Engineering Research Center,
      Universitat Politecnica de Catalunya, BarcelonaTech (UPC), Barcelona, Spain.
AD  - Biomedical Research Networking Center in Bioengineering, Biomaterials and
      Nanomedicine (CIBER-BBN), Barcelona, Spain.
LA  - eng
PT  - Journal Article
DEP - 20171219
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
PMC - PMC5736201
EDAT- 2017/12/21 06:00
MHDA- 2017/12/21 06:00
CRDT- 2017/12/21 06:00
PHST- 2017/08/11 00:00 [received]
PHST- 2017/11/26 00:00 [accepted]
PHST- 2017/12/21 06:00 [entrez]
PHST- 2017/12/21 06:00 [pubmed]
PHST- 2017/12/21 06:00 [medline]
AID - 10.1371/journal.pone.0189389 [doi]
AID - PONE-D-17-27026 [pii]
PST - epublish
SO  - PLoS One. 2017 Dec 19;12(12):e0189389. doi: 10.1371/journal.pone.0189389.
      eCollection 2017.