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

PLoS One. 2017 Dec 19;12(12):e0189389. doi: 10.1371/journal.pone.0189389. eCollection 2017.


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.

MeSH terms

  • Cardiovascular Diseases / epidemiology*
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Mediterranean Region / epidemiology
  • Middle Aged
  • Risk Assessment*
  • Risk Factors
  • Waist-Hip Ratio

Grants and funding

The baseline survey was supported by the grant number 31309304. The undersecretary of research of the ministry of health and Isfahan cardiovascular research center, cardiovascular research institute affiliated to Isfahan University of Medical Sciences funded the ICS (NS). This work was also supported by the People Programme (Marie Curie Actions) of the European Union Seventh Framework Programme (FP7/2007–2013) under REA grant agreement no. 600388 (TECNIOspring Programme), and from the Agency for Business Competitiveness of the Government of Catalonia, ACCIÓ (HRM). This work has been partially supported by the Spanish Ministry of Economy and Competitiveness, Spain (project DPI2014-59049-R) (MAM). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.