Objective 

To examine whether risk-enhancing factors integrating with the Chinese Society of Cardiology-recommended clinical risk assessment tool (i.e., the CSC model) for atherosclerotic cardiovascular disease (ASCVD) improves 10-year ASCVD risk stratification in Chinese adults. 

Methods 

A total of 4,910 Chinese participants aged 50-79 years free of cardiovascular disease in the 2007-2008 Survey from the Chinese Multi-provincial Cohort Study were included. We assessed the updated model’s clinical utility (i.e., Harrel’s C-index and net reclassification improvement [NRI]) by adding risk-enhancing factors individually or the number of risk-enhancing factors to the CSC model among all individuals or those at intermediate risk. Risk-enhancing factors, including the family history of CVD, triglycerides ≥ 2.3 mmol/L, high-sensitivity C-reactive protein ≥ 2 mg/L, Lipoprotein (a) ≥ 50 mg/dL, non-high-density lipoprotein cholesterol ≥ 4.9 mmol/L, overweight/obesity, and central obesity, were evaluated in the current analysis. ASCVD events were defined as a composite endpoint comprising ischemic stroke and acute coronary heart disease events (including nonfatal acute myocardial infarction and all coronary deaths).   

Results 

During a median of 10-year follow-up, 449 (9.1%) ASCVD events were recorded. Adding ≥ 2 risk-enhancing factors to the CSC model yielded significant improvement in C-index (1.0%, 95% confidence interval [CI]: 0.2% to 1.7%) and modest improvement in NRI (2.0%, 95% CI: -1.2% to 5.4%) in the total population. For intermediate-risk individuals, significant improvements in NRI were observed by adding ≥ 2 risk-enhancing factors (17.4%, 95% CI: 5.6% to 28.5%) to the CSC model, particularly among those at high risk of developing ASCVD. 

Conclusions 

Adding ≥ 2 risk-enhancing factors refines 10-year ASCVD risk stratification, particularly for intermediate-risk individuals, demonstrating their potential to help tailor targeted interventions in clinical practice.