BIBLIOTECA VIRTUAL

Centro Centroamericano de Población

Derivation, internal validation, and recalibration of a cardiovascular risk score for Latin America and the Caribbean (Globorisk-LAC): A pooled analysis of cohort studies

Autor: Brenes Camacho, Gilbert

Autor: Rosero Bixby, Luis

Autor: Stern, Dalia

Autor: Hambleton, Ian R.

Autor: Lotufo, Paulo Andrade

Autor: Di Cesare, Mariachiara

Autor: Hennis, Anselm

Autor: Ferreccio, Catterina

Autor: Irazola, Vilma

Autor: Perel, Pablo

Autor: Gregg, Edward W.

Autor: Aguilar Salinas, Carlos Alberto

Autor: Álvarez Vaz, Ramón

Autor: Amadio, Marselle Bevilacqua

Autor: Baccino, Cecilia

Autor: Bambs S., Claudia

Autor: Bastos, João Luiz Dornelles

Autor: Beckles, Gloria

Autor: Bernabé Ortiz, Antonio

Autor: Bernardo, Carla

Autor: Bloch, Katia Vergetti

Autor: Blümel, Juan Enrique

Autor: Boggia, José G.

Autor: Borges, Pollyana Kássia de Oliveira

Autor: Bravo, Miguel

Autor: Carbajal, Horacio A.

Autor: Casas Vásquez, Paola

Autor: Castillo Rascón, María Susana

Autor: Ceballos, Blanca H.

Autor: Colpani, Verônica

Autor: Cooper, Jackie A.

Autor: Cortés, Sandra

Autor: Cortés Valencia, Adrián

Autor: de Sá Cunha, Roberto

Autor: d'Orsi, Eleonora

Autor: Dow, William H.

Autor: Espeche, Walter G.

Autor: Fuchs, Flavio Danni

Autor: Pereira Costa Fuchs, Sandra Cristina

Autor: Godoy Agostinho Gimeno, Suely

Autor: Gómez Velasco, Donaji Verónica

Autor: González Chica, David Alejandro

Autor: González Villalpando, Clicerio

Autor: González Villalpando, María Elena

Autor: Grazioli, Gonzalo

Autor: Guerra, Ricardo Oliveira

Autor: Gutierrez, Laura E.

Autor: Herkenhoff Vieira, Fernando Luiz

Autor: Horimoto, Andrea Roseli Vancan Russo

Autor: Huidobro Muñoz, Laura Andrea

Autor: Koch, Elard S.

Autor: Lajous Loaeza, Martin

Autor: Furtado de Lima e Costa, Maria Fernanda

Autor: López Ridaura, Ruy

Autor: Campos Cavalcanti Maciel, Álvaro

Autor: Maestre, Gladys Elena

Autor: Manrique Espinoza, Betty Soledad

Autor: Marques, Larissa Pruner

Autor: Melgarejo Arias, Jesus David

Autor: Mena Camaré, Luis Javier

Autor: Mill, Jose Gerardo

Autor: Moreira, Leila Beltrami

Autor: Muñoz Velandia, Oscar Mauricio

Autor: Ono, Lariane Mortean

Autor: Oppermann, Karen

Autor: Ortiz Saavedra, Pedro José

Autor: de Paiva, Karina Mary

Autor: Viana Peixoto, Sérgio William

Autor: da Costa Pereira, Alexandre

Autor: Peres, Karen G.

Autor: de Anselmo Peres, Marco Aurelio

Autor: Ramírez Palacios, Paula

Autor: Rech, Cassiano Ricardo

Autor: Rivera Paredez, Berenice

Autor: Rodríguez Guerrero, Nohora Inés

Autor: Rojas Martínez, Maria Rosalba

Autor: Rubinstein, Adolfo

Autor: Ruiz Morales, Álvaro de Jesus

Autor: Salazar, Martin R.

Autor: Salinas Rodríguez, Aarón

Autor: Nájera Salmerón, Jorge Alberto

Autor: Sánchez, Ramón Augusto

Autor: de Souza e Silva, Nelson Albuquerque

Autor: Nogueira da Silva, Thiago Luiz

Autor: Smeeth, Liam

Autor: Spritzer, Poli Mara

Autor: Tartaglione, Fiorella

Autor: Tartaglione, Jorge

Autor: Tello Rodríguez, Tania

Autor: Velázquez Cruz, Rafael

Autor: Cohorts Consortium of Latin America and the Caribbean (CC-LAC)

Autor: Carrillo Larco, Rodrigo Martín

Autor: Miranda Montero, Juan J.

Autor: Ezzati, Majid

Autor: Danaei, Goodarz

Resumen

Background: Risk stratification is a cornerstone of cardiovascular disease (CVD) prevention and a main strategy proposed to achieve global goals of reducing premature CVD deaths. There are no cardiovascular risk scores based on data from Latin America and the Caribbean (LAC) and it is unknown how well risk scores based on European and North American cohorts represent true risk among LAC populations. Methods: We developed a CVD (including coronary heart disease and stroke) risk score for fatal/non-fatal events using pooled data from 9 prospective cohorts with 21,378 participants and 1,202 events. We developed laboratory based (systolic blood pressure, total cholesterol, diabetes, and smoking), and office-based (body mass index replaced total cholesterol and diabetes) models. We used Cox proportional hazards and held back a subset of participants to internally validate our models by estimating Harrell’s C-statistic and calibration slopes. Findings: The C-statistic for the laboratory-based model was 72% (70−74%), the calibration slope was 0.994 (0.934−1.055) among men and 0.852 (0.761−0.942) among women; for the office-based model the C-statistic was 71% (69−72%) and the calibration slope was 1.028 (0.980−1.076) among men and 0.811 (0.663−0.958) among women. In the pooled sample, using a 20% risk threshold, the laboratory-based model had sensitivity of 21.9% and specificity of 94.2%. Lowering the threshold to 10% increased sensitivity to 52.3% and reduced specificity to 78.7%. Interpretation: The cardiovascular risk score herein developed had adequate discrimination and calibration. The Globorisk-LAC would be more appropriate for LAC than the current global or regional risk scores. This work provides a tool to strengthen risk-based cardiovascular prevention in LAC.

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