An office-based cardiovascular prediction model developed and validated in cohort studies of a middle-income country

J Clin Epidemiol. 2022 Jun:146:1-11. doi: 10.1016/j.jclinepi.2021.12.017. Epub 2021 Dec 15.


Objective: Prediction models for cardiovascular disease (CVD) mortality come from high-income countries, comprising laboratory measurements, not suitable for resource-limited countries. This study aims to develop and validate a non-laboratory model to predict CVD mortality in a middle-income setting.

Study design and setting: We used data of population aged 40-80 years from three cohort studies: Tehran Lipid and Glucose Study (n = 5160), Isfahan Cohort Study (n = 4350), and Golestan Cohort Study (n = 45,500). Using Cox proportional hazard models, we developed prediction models for men and women, separately. Cross-validation and bootstrapping procedures were applied. The models' discrimination and calibration were assessed by concordance statistic (C-index) and calibration plot, respectively. We calculated the models' sensitivity, specificity and net benefit fraction in a threshold probability of 5%.

Results: The 10-year CVD mortality risks were 5.1% (95%CI: 4.8-5.5) in men and 3.1% (95%CI: 2.9%-3.3%) in women. The optimism-corrected performance of the model was c = 0.774 in men and c = 0.798 in women. The models showed good calibration in both sexes, with a predicted-to-observed ratio of 1.07 in men and 1.09 in women. The sensitivity was 0.76 in men and 0.66 in women. The net benefit fraction was higher in men compared to women (0.46 vs. 0.35).

Conclusion: A low-cost model can discriminate well between low- and high-risk individuals, and can be used for screening in low-middle income countries.

Keywords: Cardiovascular disease; Low-Middle income; Mortality; Prediction; Risk; Screening.

MeSH terms

  • Cardiovascular Diseases* / diagnosis
  • Cohort Studies
  • Female
  • Humans
  • Iran / epidemiology
  • Male
  • Probability
  • Proportional Hazards Models
  • Risk Assessment / methods
  • Risk Factors