Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb 13:43:101009.
doi: 10.1016/j.lana.2025.101009. eCollection 2025 Mar.

Prediction of cardiovascular risk: validation of a non-laboratory and a laboratory-based score in a Brazilian community-based cohort of the PURE study

Gustavo Bernardes de Figueiredo Oliveira  1 , Rafael Amorim Belo Nunes  1 , Lucas Bassolli de Oliveira Alves  1 , Precil Diego Miranda de Menezes Neves  1 , Victor Augusto Hamamoto Sato  1 , Ana Heloisa Kamada Triboni  1 , Haliton Alves de Oliveira Júnior  1 , Priscila Raupp da Rosa  2 , Maria Luz Díaz  3 , Jose Patricio Lopez-Jaramillo  4 , Fernando Lanas  5 , Philip Joseph  6 , Álvaro Avezum  1   6
Affiliations

Prediction of cardiovascular risk: validation of a non-laboratory and a laboratory-based score in a Brazilian community-based cohort of the PURE study

Gustavo Bernardes de Figueiredo Oliveira et al. Lancet Reg Health Am. .

Abstract

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.

Keywords: Brazil; Cardiovascular disease; Risk factors; Risk score; Validation study.

PubMed Disclaimer

Conflict of interest statement

Dr. Priscila Raupp da Rosa is an employee of Novartis Biociências Brazil. Prof. Álvaro Avezum has a contract with PHRI for research funding at Hospital Alemão Oswaldo Cruz and is an advisory board member of OPTIMAL DIABETES, OPTIMAL STROKE, ACHIEVE-BP and IMPACT-BP studies. The other authors declare no competing interests related to this research.

Figures

Fig. 1
Fig. 1
ROC curves for the overall, urban, and rural population for non-laboratory INTERHEART risk score (NL-IHRS) and fasting-cholesterol INTERHEART risk score (FC-IHRS).
See this image and copyright information in PMC

References

    1. Dagenais G.R., Leong D.P., Rangarajan S., et al. Variations in common diseases, hospital admissions, and deaths in middle-aged adults in 21 countries from five continents (PURE): a prospective cohort study. Lancet. 2020;395(10226):785–794. - PubMed
    1. Magnussen C., Ojeda F.M., Leong D.P., et al. Global Cardiovascular Risk Consortium Global effect of modifiable risk factors on cardiovascular disease and mortality. N Engl J Med. 2023;389(14):1273–1285. - PMC - PubMed
    1. Marinho F., de Azeredo Passos V.M., Malta D.C., et al. Burden of disease in Brazil, 1990–2016: a systematic subnational analysis for the global burden of disease study 2016. Lancet. 2018;392:760–775. - PMC - PubMed
    1. Roth G.A., Johnson C., Abajobir A., et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol. 2017;70:1–25. - PMC - PubMed
    1. Roth G.A., Mensah G.A., Johnson C.O., et al. Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study. J Am Coll Cardiol. 2020;76:2982–3021. - PMC - PubMed

LinkOut - more resources