: the INTERHEART Modifiable Risk Score
- Catherine McGorrian1,2,
- Salim Yusuf1,
- Shofiqul Islam1,
- Hyejung Jung1,
- Sumathy Rangarajan1,
- Alvaro Avezum3,
- Dorairaj Prabhakaran4,
- Wael Almahmeed5,
- Zvonko Rumboldt6,
- Andrzej Budaj7,
- Antonio L. Dans8,
- Hertzel C. Gerstein1,
- Koon Teo1 and
- Sonia S. Anand1,* on behalf of the INTERHEART Investigators
Abstract
Aims Summating risk factor burden is a useful approach in the assessment of cardiovascular risk among apparently healthy individuals. We aimed to derive and validate a new score for myocardial infarction (MI) risk using modifiable risk factors, derived from the INTERHEART case–control study (n = 19 470).
Methods and results Multiple logistic regression was used to create the INTERHEART Modifiable Risk Score (IHMRS). Internal validation was performed using split-sample methods. External validation was performed in an international prospective cohort study. A risk model including apolipoproteins, smoking, second-hand smoke exposure, hypertension, and diabetes was developed. Addition of further modifiable risk factors did not improve score discrimination in an external cohort. Split-sample validation studies showed an area under the receiver-operating characteristic (ROC) curve c-statistic of 0.71 [95% confidence interval (CI): 0.70, 0.72]. The IHMRS was positively associated with incident MI in a large cohort of people at low risk for cardiovascular disease [12% increase in MI risk (95% CI: 8, 16%) with a 1-point increase in score] and showed appropriate discrimination in this cohort (ROC c-statistic 0.69, 95% CI: 0.64, 0.74). Results were consistent across ethnic groups and geographic regions. A non-laboratory-based score is also supplied.
Conclusions Using multiple modifiable risk factors from the INTERHEART case–control study, we have developed and validated a simple score for MI risk which is applicable to an international population.
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