Cardiovascular disease risk score prediction models for women and its applicability to Asians

Figures & data

Table 1 Characteristics of the cohort of 4,354 women without heart disease, diabetes, or stroke by ethnicity

	Statistics	Australia	United Kingdom and Ireland	Northern Europe	Southern Europe	Asia
Count	N	3,329	416	180	234	195
Age (years)	Mean ± SD	41.9±13.5	45.7±12.5	49.0±11.7	47.8±10.6	40.5±10.9
Weight (kg)	Mean ± SD	65.4±12.6	65.2±12.0	66.5±12.6	66.9±11.8	58.6±11.6
Height (cm)	Mean ± SD	162.8±6.0	162.3±6.2	161.9±6.2	156.8±6.1	156.7±5.7
BMI (≥30 kg/m^2)	N (%)	403 (12.2%)	49 (11.8%)	29 (16.2%)	45 (19.7%)	18 (9.3%)
	OR (95% CI)	1.29 (0.78, 2.12)	1.12 (0.63, 1.99)	1.49 (0.79, 2.80)	1.96 (1.09, 3.54)	Ref
WC (≥80 cm)	N (%)	988 (29.8%)	134 (32.2%)	62 (34.4%)	123 (52.8%)	47 (24.2%)
	OR (95% CI)	1.22 (0.87, 1.73)	1.17 (0.78, 1.74)	1.12 (0.70, 1.78)	2.65 (1.72, 4.07)	Ref
WHR (≥0.8)	N (%)	732 (22.0%)	102 (24.6%)	49 (27.2%)	98 (42.1%)	44 (22.7%)
	OR (95% CI)	0.86 (0.60, 1.23)	0.85 (0.56, 1.29)	0.85 (0.52, 1.38)	1.83 (1.18, 2.83)	Ref
WSR (≥0.5)	N (%)	895 (27.1%)	116 (28.0%)	61 (33.9%)	131 (56.7%)	50 (25.9%)
	OR (95% CI)	0.95 (0.68, 1.34)	0.83 (0.55, 1.24)	0.95 (0.60, 1.51)	2.78 (1.81, 4.26)	Ref
SBP (≥130 mmHg)	N (%)	923 (27.7%)	135 (32.5%)	65 (36.1%)	93 (39.7%)	39 (20.0%)
	OR (95% CI)	1.29 (0.86, 1.93)	1.19 (0.75, 1.88)	1.06 (0.63, 1.81)	1.50 (0.92, 2.45)	Ref
DBP (≥85 mmHg)	N (%)	645 (19.4%)	81 (19.5%)	48 (26.7%)	71 (30.3%)	23 (11.9%)
	OR (95% CI)	1.56 (0.98, 2.47)	1.25 (0.75, 2.11)	1.61 (0.91, 2.86)	2.18 (1.28, 3.74)	Ref
HDL (≥1.3 mmol/L)	N (%)	2,259 (69.3%)	287 (70.2%)	119 (70.0%)	144 (62.9%)	122 (65.6%)
	OR (95% CI)	1.18 (0.86, 1.61)	1.20 (0.83, 1.73)	1.16 (0.74, 1.82)	0.85 (0.57, 1.28)	Ref
TC (≥5.5 mmol/L)	N (%)	1,431 (43.9%)	214 (52.3%)	91 (53.5%)	130 (56.8%)	66 (35.5%)
	OR (95% CI)	1.37 (0.99, 1.90)	1.57 (1.07, 2.29)	1.31 (0.83, 2.06)	1.66 (1.09, 2.52)	Ref
Triglycerides (≥1.7 mmol/L)	N (%)	390 (12.0%)	61 (14.9%)	29 (17.1%)	37 (16.2%)	31 (16.7%)
	OR (95% CI)	0.60 (0.40, 0.91)	0.68 (0.42, 1.10)	0.69 (0.39, 1.21)	0.70 (0.41, 1.19)	Ref
Current smoker (Yes)	N (%)	751 (22.6%)	91 (21.9%)	39 (21.7%)	32 (13.7%)	19 (9.7%)
	OR (95% CI)	2.78 (1.72, 4.50)	2.91 (1.71, 4.94)	3.09 (1.70, 5.61)	1.72 (0.94, 3.16)	Ref

Notes: Odds ratio and associated 95% confidence intervals were calculated using logistic regression after adjusting for age.

Abbreviations: BMI, body mass index; CI, confidence interval; DBP, diastolic blood pressure; HDL, high density lipoprotein; OR, odds ratio; SBP, systolic blood pressure; TC, total cholesterol; WC, waist circumference; WHR, waist-to-hip ratio; WSR, waist-to-stature ratio; N, number; Ref, reference group.

Table 2 Predicted 10-year cardiovascular disease incidence and/or mortality risk (%) in 4,354 women without heart disease, diabetes, or stroke by ethnicity

	Australia	United Kingdom and Ireland	Northern Europe	Southern Europe	Asia
Cardiovascular disease mortality
Framingham risk score model
Median (%) (25th, 75th percentile)	0.08 (0.02, 0.49)	0.14 (0.03, 0.83)	0.21 (0.05, 1.41)	0.31 (0.05, 1.01)	0.04 (0.01, 0.18)
P-value	<0.0005	<0.0005	<0.0005	<0.0005	Ref
SCORE risk chart for low-risk regions
Median (%) (25th, 75th percentile)	0.05 (0, 0.50)	0.15 (0.02, 0.75)	0.21 (0.05, 1.66)	0.27 (0.05, 0.97)	0.03 (0.01, 0.23)
P-value	0.176	<0.0005	<0.0005	<0.0005	Ref
SCORE risk chart for high-risk regions
Median (%) (25th, 75th percentile)	0.08 (0.01, 0.78)	0.24 (0.04, 1.21)	0.34 (0.08, 2.43)	0.43 (0.08, 1.49)	0.05 (0.01, 0.35)
P-value	0.167	<0.0005	<0.0005	<0.0005	Ref
Cardiovascular disease incidence and mortality
General cardiovascular disease risk score model
Median (%) (25th, 75th percentile)	2.26 (1.05, 6.08)	3.57 (1.55, 7.89)	4.05 (2.14, 10.11)	4.98 (2.07, 8.24)	1.77 (0.94, 4.06)
P-value	0.005	<0.0005	<0.0005	<0.0005	Ref
Simplified general cardiovascular disease risk score model
Median (%) (25th, 75th percentile)	2.32 (0.99, 6.25)	3.50 (1.42, 7.55)	4.14 (2.04, 9.54)	4.76 (2.17, 8.49)	1.72 (0.87, 3.83)
P-value	0.001	<0.0005	<0.0005	<0.0005	Ref
Cardiovascular disease incidence
Framingham risk score model
Median (%) (25th, 75th percentile)	3.95 (1.19, 12.79)	6.96 (2.30, 16.81)	8.38 (3.79, 19.34)	10.19 (3.65, 17.17)	2.79 (0.95, 8.25)
P-value	0.010	<0.0005	<0.0005	<0.0005	Ref

Abbreviations: SCORE, Systematic COronary Risk Evaluation; Ref, reference group.

Table 3 Predicted 10-year CHD incidence and/or mortality risk (%) in 4,354 women without heart disease, diabetes, or stroke by ethnicity

	Australia	United Kingdom and Ireland	Northern Europe	Southern Europe	Asia
Coronary heart disease mortality
Framingham risk score model
Median (%) (25th, 75th percentile)	0.01 (0, 0.19)	0.03 (0, 0.42)	0.07 (0, 0.73)	0.13 (0.01, 0.52)	0 (0, 0.07)
P-value	0.081	<0.0005	<0.0005	<0.0005	Ref
SCORE risk chart for low-risk regions
Median (%) (25th, 75th percentile)	0.02 (0, 0.27)	0.08 (0.01, 0.41)	0.12 (0.02, 0.84)	0.14 (0.03, 0.49)	0.02 (0, 0.11)
P-value	0.161	<0.0005	<0.0005	<0.0005	Ref
SCORE risk chart for high-risk regions
Median (%) (25th, 75th percentile)	0.05 (0, 0.49)	0.15 (0.02, 0.75)	0.21 (0.05, 1.48)	0.26 (0.05, 0.89)	0.03 (0.01, 0.20)
P-value	0.156	<0.0005	<0.0005	<0.0005	Ref
Coronary heart disease incidence and mortality
General cardiovascular disease risk score model
Median (%) (25th, 75th percentile)	1.38 (0.64, 3.70)	2.17 (0.94, 4.80)	2.47 (1.30, 6.15)	3.03 (1.26, 5.02)	1.08 (0.57, 2.47)
P-value	0.005	<0.0005	<0.0005	<0.0005	Ref
Simplified general cardiovascular disease risk score model
Median (%)(25th, 75th percentile)	1.41 (0.61, 3.80)	2.13 (0.86, 4.59)	2.52 (1.24, 5.81)	2.90 (1.32, 5.17)	1.05 (0.53, 2.33)
P-value	0.001	<0.0005	<0.0005	<0.0005	Ref
Coronary heart disease incidence
Framingham risk score model
Median (%) (25th, 75th percentile)	1.99 (0.17, 8.33)	4.45 (0.87, 11.00)	5.20 (1.99, 11.90)	7.01 (2.04, 11.89)	1.52 (0.22, 6.15)
P-value	0.317	<0.0005	<0.0005	<0.0005	Ref

Abbreviations: CHD, coronary heart disease; SCORE, Systematic COronary Risk Evaluation; Ref, reference group.

Table 4 Cardiovascular disease prevalence in adults (age ≥18 years) by ethnicity

	Australia	United Kingdom	Northern Europe	Southern Europe	Asia
ABS (2011–2012)^Citation42,Citation43	3.2%	6.1%	5.8%	7.7%	2.9%
ABS (2007–2008)^Citation44	3.7%	6.5%	8.2%	9.9%	2.4%
ABS (2004–2005)^Citation45	2.6%	5.8%	6.5%	4.9%	2.2%

Abbreviation: ABS, Australian Bureau of Statistics.

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