Preventive cardiology
A Coronary Heart Disease Risk Score Based on Patient-Reported Information

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To develop a simple, patient self-report–based coronary heart disease (CHD) risk score for adults without previously diagnosed CHD (Personal Heart Early Assessment Risk Tool [HEART] score), the Atherosclerosis Risk In Communities (ARIC) Study, a prospective cohort of subjects aged 45 to 64 years at baseline, was used to develop a measure for 10-year risk of CHD (n = 14,343). Variables evaluated for inclusion were age, history of diabetes mellitus, history of hypercholesterolemia, history of hypertension, family history of CHD, smoking, physical activity, and body mass index. The 10-year risk of CHD events was defined as myocardial infarction, fatal CHD, or cardiac procedure. The new measure was compared with the Framingham Risk Score (FRS) and European Systematic Coronary Risk Evaluation (SCORE). The Personal HEART score for men included age, diabetes, hypertension, hypercholesterolemia, smoking, physical activity, and family history. In men, the area under the receiver-operator characteristic curve for predicting 10-year CHD for the Personal HEART score (0.65) was significantly different from that for the FRS (0.69, p = 0.03), but not for the European SCORE (0.62, p = 0.12). The Personal HEART score for women included age, diabetes, hypertension, hypercholesterolemia, smoking, and body mass index. The area under the curve for the Personal HEART score (0.79) for women was not significantly different from that for the FRS (0.81, p = 0.42) and performed better than the European SCORE (0.69, p = 0.01). In conclusion, the Personal HEART score identifies 10-year risk for CHD based on self-report data, is similar in predictive ability to the FRS and European SCORE, and has the potential for easy self-assessment.

Section snippets

Methods

For this study, we used the Atherosclerosis Risk In Communities (ARIC) Study public use data. The ARIC is a large-scale prospective cohort that also includes a community surveillance component and is composed of black and nonblack men and women age 45 to 64 years at entry (1987 to 1989) with follow-up to December 31, 1998. Follow-up examinations were conducted in 1990 to 1992, 1993 to 1995, and 1996 to 1998.

The present analysis was limited to persons who did not have previously diagnosed CHD or

Results

Baseline characteristics of men and women in the ARIC cohort are listed in Table 1.Table 2 lists hazard ratios from the reduced-variable model in men and assignment of risk score points based on hazards ratios. In addition, the Personal HEART score for men includes several variables not included in the FRS or European SCORE, specifically family history of CHD and physical activity. In Table 3, hazard ratios from the reduced-variable model in women indicate a core set of variables similar to

Discussion

Many studies have sought to improve CHD risk scoring systems by increasing the number of risk factors assessed, most often requiring clinicians to obtain more laboratory or examination data.13, 23 In contrast, this study sought to develop and validate a risk score using self-report data to provide a simple method of initial risk assessment to be used by clinicians immediately within 1 office visit, and it can be used by patients without requiring immediate access to a clinician to obtain

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    This work was supported in part by Grant No. 1D14 HP 00161 from the Health Resources and Services Administration, Rockville, Maryland; Grant No. 1 P30AG021677 from the National Institute on Aging; Grant No. 5P60MD000267 (EXPORT) from the National Institutes of Health, Bethesda, Maryland; and Grant No. 051896 from the Robert Wood Johnson Foundation, Princeton, New Jersey. The Atherosclerosis Risk in Communities Study is conducted and supported by The National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the ARIC Study Investigators.

    This work was prepared using a limited access dataset obtained by the NHLBI and does not necessarily reflect the opinions or views of the ARIC Study or the NHLBI.

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