Disease Risk Score Derivation and Validation in Abu Dhabi, United Arab Emirates: A Retrospective Cohort Study.

Abstract

Background: Cardiovascular disease risk assessment is a key tool in primary prevention. The ADRS (Abu Dhabi Risk Study) is a retrospective cohort study aiming to develop 10-year risk prediction equations for coronary artery disease (CAD), stroke, and atherosclerotic cardiovascular disease (ASCVD), and validate international risk equations.

Methods and results: The 8699 participants were examined in the Abu Dhabi cardiovascular screening program from 2011 to 2013 with a subsequent average follow-up of 9.2 years. They were assessed in 2023 for new CAD, admissions for acute coronary syndrome, or stroke. The validation cohort, 2554 subjects, is from the 2016 to 2017 Abu Dhabi community screening program, with 6.67 years average follow-up. Of 8504 ASCVD-free subjects, 250 experienced new CAD events. ASCVD risk factors in this population were age, sex, smoking, high cholesterol/high-density lipoprotein ratio, and diabetes diagnosis, in addition to low vitamin D level and low glomerular filtration rate. Three ADRS prediction models were derived using Cox regression. The ADRS-CAD had a C statistic of 0.899 (0.882-0.916) compared with 0.828 (0.803-0.852) for the Framingham Risk Score in the same sample. ADRS-stroke had a C statistic of 0.904 (0.865-0.944). The ADRS-ASCVD had a C statistic of 0.898 (0.883-0.913) compared with 0.891 (0.875-0.907) of pooled cohort equations and 0.825 (0.802-0.847) for Framingham Risk Score-cardiovascular disease. Applying our formulas to the validation cohort yielded C statistics of 0.825 (0.803-0.846), 0.799 (0.774-0.824), and 0.761 (0.71-0.813) for ASCVD, CAD, and stroke, respectively. The pooled cohort equations in this cohort had a C statistic for ASCVD of 0.824 (0.802-0.846).

Conclusions: This study demonstrates the value of tailoring risk assessments to local populations and health care contexts.