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Estimation of 10-Year Risk of Death from Coronary Heart Disease, Stroke, and Cardiovascular Disease in a Pooled Analysis of Japanese Cohorts: EPOCH-JAPAN.

  • Li, Yuanying1
  • Yatsuya, Hiroshi1, 2
  • Tanaka, Sachiko3
  • Iso, Hiroyasu4
  • Okayama, Akira5
  • Tsuji, Ichiro6
  • Sakata, Kiyomi7
  • Miyamoto, Yoshihiro8
  • Ueshima, Hirotsugu9
  • Miura, Katsuyuki9, 10
  • Murakami, Yoshitaka11
  • Okamura, Tomonori12
  • 1 Department of Public Health, Fujita Health University School of Medicine.
  • 2 Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University.
  • 3 Department of Medical Statistics, Shiga University of Medical Science.
  • 4 Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine.
  • 5 Research Institute for Lifestyle-Related Disease Prevention.
  • 6 Division of Epidemiology, Department of Health Informatics & Public Health, Tohoku University School of Public Health, Graduate School of Medicine.
  • 7 Department of Hygiene and Preventive Medicine, School of Medicine, Iwate Medical University.
  • 8 Department of Preventive Cardiology, National Cerebral and Cardiovascular Center.
  • 9 Department of Public Health, Shiga University of Medical Science.
  • 10 Center for Epidemiologic Research in Asia, Shiga University of Medical Science.
  • 11 Department of Medical Statistics, Toho University School of Medicine.
  • 12 Department of Preventive Medicine and Public Health, Keio University School of Medicine.
Published Article
Journal of atherosclerosis and thrombosis
Publication Date
Aug 01, 2021
DOI: 10.5551/jat.58958
PMID: 33041313


We aimed to develop and validate risk prediction models to estimate the absolute 10-year risk of death from coronary heart disease (CHD), stroke, and cardiovascular disease (CVD). We evaluated a total of 44,869 individuals aged 40-79 years from eight Japanese prospective cohorts to derive coefficients of risk equations using cohort-stratified Cox proportional hazard regression models. Discrimination (C-index) of the equation was examined in each cohort and summarised using random-effect meta-analyses. Calibration of the equation was assessed using Hosmer-Lemeshow chi-squared statistic. Within a median follow-up of 12.7 years, we observed 765 deaths due to CVD (276 CHDs and 489 strokes). After backward selection, age, sex, current smoking, systolic blood pressure (SBP), proteinuria, prevalent diabetes mellitus, the ratio of total cholesterol to high-density lipoprotein cholesterol (TC/HDLC), interaction terms of age by SBP, and age by current smoking were retained as predictors for CHD. Sex was excluded in the stroke equation. We did not consider TC/HDLC as a risk factor for the stroke and CVD equations. The pooled C-indices for CHD, stroke, and CVD were 0.83, 0.80, and 0.81, respectively, and the corresponding p-values of the Hosmer-Lemeshow tests were 0.18, 0.003, and 0.25, respectively. Risk equations in the present study can adequately estimate the absolute 10-year risk of death from CHD, stroke, and CVD. Future work will evaluate the system as an education and risk communication tool for primary prevention of CHD and stroke.

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