Risk stratification of atherosclerotic cardiovascular disease in Chinese adults

Abstract

Objective: This study aims to determine the distribution of observed atherosclerotic cardiovascular disease (ASCVD) incidence in contemporary cohorts in China, and to identify cut-off points for ASCVD risk classification based on traditional criteria and new equations developed by Prediction for ASCVD Risk in China (China-PAR).

Methods: The study populations included cohorts in the China-PAR project, with 34,757 participants eligible for the current analysis. Traditional risk stratification was assessed by using Chinese guidelines on prevention of CVD and hypertension, and 5 risk groups were classified based on these guidelines after slight modification for available risk factors. Kaplan-Meier analysis was conducted to obtain the cumulative incidence of observed ASCVD events for all subjects and sub-groups. The predicted 10-year ASCVD risk was obtained using the China-PAR equations.

Results: A total of 1922 ASCVD events were identified during an average follow-up of 14.1 years. According to the group classification based on traditional risk stratification, the observed 10-year risks for ASCVD were 4.61% (95% confidence interval [CI]: 4.11-5.10%) in the moderate-risk group and 8.74% (95% CI: 7.82-9.66%) in the high-risk group. Based on the China-PAR equations for risk assessment of ASCVD, those with predicted risks of <5%, 5-10%, and ≥10% could be classified into categories of low-, moderate-, and high-risk for ASCVD, respectively.

Conclusion: The findings enable development of a simple method for classification of individuals into low-, moderate-, and high-risk groups, based on the China-PAR equations. The method will be useful for self-management and prevention of ASCVD in Chinese adults.

Keywords: Atherosclerotic cardiovascular disease; China-PAR project; Cohort; Risk stratification.

Fig. 1

Incidence of ASCVD across different risk stratification groups. The 3 solid lines show the incidence of ASCVD based on the Chinese Guideline on Prevention of CVD, with the very low and low group as the green line, the moderate group as the blue line, and the high and very high group as the red line. The 3 dashed lines show the incidence of ASCVD based on the cut-off points from the China-PAR equations, with green, blue, and red dashed lines for <5%, 5–10%, and ≥10%, respectively. ASCVD: atherosclerotic cardiovascular disease. China-PAR project: Prediction for ASCVD Risk in China project.

Fig. 2

Ten-year Kaplan–Meier observed and predicted ASCVD event rates among 34,757 participants in the cohorts from the China-PAR Project. The observed ASCVD rates after Kaplan–Meier-adjustment are shown as white bars, and the predicted ASCVD rates using the China-PAR equations are shown as black bars. ASCVD: atherosclerotic cardiovascular disease; China-PAR: Prediction for ASCVD Risk in China.