Abstract
A stroke prediction model based on the Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR) project was developed. We compared its predictive ability with the revised Framingham Stroke Risk Score (R-FSRS) for 5-year stroke incidence in a community cohort of Chinese adults, namely the Beijing Longitudinal Study of Aging (BLSA). Calibration, discrimination, and recalibration were used to compare the predictive ability between the two prediction models. Category-less net reclassification improvement (NRI) and integrated discrimination improvement (IDI) values were also assessed. During a mean follow-up duration of 5.1 years, 106 incidents of fatal or non-fatal strokes occurred among 1,203 participants aged 55–84 years. The R-FSRS applied to our cohort underestimated the 5-year risk for stroke in men and women. China-PAR performed better than the R-FSRS in terms of calibration (men, R-FSRS: χ2-value 144.2 [P < 0.001], China-PAR: 10.4 [P = 0.238]; women, R-FSRS: 280.1 [P < 0.001], China-PAR: 12.5 [P = 0.129]). In terms of discrimination, R-FSRS and China-PAR models performed modestly in our cohort (C-statistic 0.603 [95% CI: 0.560–0.644] for men using China-PAR and 0.568 [95% CI: 0.524–0.610] using the R-FSRS; the corresponding numbers for women were 0.602 [95% CI: 0.564–0.639] and 0.575 [95% CI: 0.537–0.613). The recalibrated China-PAR model significantly improved the discrimination in C statistics and produced higher category-less NRI and IDI for stroke incidence than the R-FSRS. Although China-PAR fairly estimated stroke risk in our cohort, it did not sufficiently identify adults at high risk of stroke. Caution would be exercised by practitioners in applying the original China-PAR to Chinese older adults. Further studies are needed to develop an adequate prediction model based on the recalibrated China-PAR or to find new risk markers which could upgrade this model.
Highlights
Stroke is the second most prevalent cause of death and disability [1], in the aged population, which presents a large proportion of the Chinese population, with population aging having significantly increased stroke incidence [2]
Several multivariate risk prediction models have been developed following the original Framingham Stroke Risk Score (FSRS), which is based on various vascular risk factors for predicting the risk of initial stroke [4,5,6,7,8]
The proportions of participants with diabetes and of those taking antihypertensive medication were smaller among men than among women, whereas the proportion of current smokers was substantially greater among the former
Summary
Stroke is the second most prevalent cause of death and disability [1], in the aged population, which presents a large proportion of the Chinese population, with population aging having significantly increased stroke incidence [2]. The prevalence and incidence of stroke have increased in China over the past 3 decades. Most prediction models have been developed based on Western populations. In 2019, Xing et al [9] established a new stroke prediction model aimed at predicting stroke risk among Chinese individuals included in the Prediction for Atherosclerotic Cardiovascular Disease Risk in China (ChinaPAR) project. The China-PAR stroke risk models were developed based on a middle-aged cohort (40–79 years, mean age 48.6 years) and included factors such as age and age-related diseases. Whether these findings are generalizable in elderly populations of the community is unknown
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