OC06_10 Applicability of a Non-Laboratory- and a Laboratory Based Cardiovascular Disease Risk Score Across Seven Regions of the World

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Introduction: In most regions of the world, cardiovascular disease (CVD) risk scores have undergone limited evaluation in prospective cohort studies to determine their accuracy for estimating CVD risk. Objectives: We evaluated the performance of the Non-laboratory INTERHEART Risk Score (NL-IHRS) and fasting-cholesterol based IHRS (FC-IHRS) across seven distinct geographic regions in the Prospective Urban Rural Epidemiology (PURE) study. Methods: We tested the performance of the NL-IHRS (N1⁄498,775) and FC-IHRS (N1⁄4108,516) for predicting incident CVD in a community-based, prospective study across 7 geographic regions: South Asia, China, Southeast Asia, Middle East, Europe/ North America, South America and Africa. CVD was defined as the composite outcome of cardiovascular death, myocardial infarction, stroke, heart failure or coronary revascularization. The performance of the score was evaluated using measures of discrimination (e.g. concordance-statistic [C-statistic]) and calibration (e.g. intercept and calibration slope). Results: The NL-IHRS had satisfactory discrimination for incident CVD, although recalibration was necessary in all regions, which improved its overall performance (C-statistic (0.67 to 0.71, p <0.001). Regional discrimination was highest in South America and the Middle East (C-statistic 1⁄4 0.72 in both regions) and lowest in South Asia (C-statistic 1⁄4 0.61). Regional recalibration was also necessary for the FC-IHRS, which also improved its overall discrimination (C-statistic 0.70 to 0.73, p<0.001). In 83,880 participants with complete data for both scores, the FC-IHRS performed better than the NL-IHRS although absolute differences were small (C-statistic 0.71 vs. 0.72, p<0.001). Conclusion: External validation of the NL-IHRS and FC-IHRS in the PURE study suggests that regionally recalibrated versions of both are useful for estimating CVD risk across a diverse range of community-dwelling populations from diverse geographic regions. The NL-IHRS may be used as an alternative to a cholesterol-based risk prediction tool with only a modest reduction in accuracy. Disclosure of Interest: None Declared