HK-Chinese model predicts 10-year ASCVD risk in patients with schizophrenia-spectrum disorders

10 Apr 2026
Kanas Chan
Kanas ChanAssociate Editor; MIMS
Kanas Chan
Kanas Chan Associate Editor; MIMS
HK-Chinese model predicts 10-year ASCVD risk in patients with schizophrenia-spectrum disorders

A Hong Kong–Chinese (HK-Chinese) model achieves satisfactory accuracy in predicting 10-year atherosclerotic cardiovascular disease (ASCVD) risk in Chinese patients with schizophrenia-spectrum disorders, according to a population-based cohort study.

Patients with schizophrenia have 15–20 years shorter life expectancy than the general population, with cardiovascular disease (CVD) being the leading cause of excess deaths, rather than suicide. [Schizophr 2025;11:117; Epidemiol Psychiatr Sci 2017;27:519-527]

Two risk models (ie, PREDICT and PRIMROSE) have shown adequate performance in ASCVD risk prediction among patients with schizophrenia, but these were validated mainly in European patients, with Chinese patients being underrepresented. “To date, no study has been conducted to develop and validate a model for predicting the 10-year risk of ASCVD in a population of ethnic Chinese patients with schizophrenia-spectrum disorders,” wrote the researchers. [PLoS One 2019;14:e0221521; JAMA Psychiatry 2015;72:143-151; Schizophr Res 2026;292:88-95]

Researchers from the University of Hong Kong (HKU) therefore developed the HK-Chinese model for 10-year ASCVD risk estimation using a cohort of 39,427 Chinese patients who received a diagnosis of schizophrenia-spectrum disorders (mean age, 47.38 years; male, 47.2 percent) between 2005 and 2015. The primary outcome was incident ASCVD over 10 years. [Schizophr Res 2026;292:88-95]

During the 10-year follow-up period, 1,749 patients (4.4 percent) developed an incident ASCVD event. The most common event was fatal or nonfatal stroke, followed by nonfatal MI and death from coronary heart disease. “The cumulative incidence of ASCVD was notably higher than that of general White Europeans and East Asians,” noted the researchers.

Significant predictors of ASCVD included:

  1.  Male gender (hazard ratio [HR], 1.51; 95 percent confidence interval [CI], 1.34–1.69; p<0.001);
  2. Age (per log-year increase; HR, 1.07; 95 percent CI, 1.07–1.08; p<0.001);
  3. Untreated hypertension (HR, 2.09; 95 percent CI, 1.57–2.77; p<0.001);
  4. Treated hypertension (HR, 1.55; 95 percent CI, 1.37–1.75; p<0.001);
  5. Diabetes (HR, 1.73; 95 percent CI, 1.48–2.03; p<0.001);
  6. Longer duration of exposure to first-generation antipsychotics (HR, 1.03; 95 percent CI, 1.01–1.05; p<0.001);
  7. Index year of schizophrenia diagnosis (HR, 0.93; 95 percent CI, 0.91–0.95; p<0.001).

These seven parameters were used to develop the HK-Chinese model. In contrast, the PROMISE-with a reduced set of parameters (PROMISE-reduced model) used eight parameters.

The HK‑Chinese model demonstrated satisfactory predictive performance, with an overall C statistic of 0.81 and a D statistic of 2.02. “Despite having one fewer parameter, it performed as well as the PRIMROSE-reduced model, indicating that the HK-Chinese model may be preferred for its greater parsimony,” highlighted the researchers.

Both models tended to overestimate ASCVD risk in patients in the highest predicted risk category (>90th percentile; predicted risk >20 percent). “We interpret that a predicted risk score >20 percent may not accurately reflect the observed risk in this study. Depending on individual patients’ clinical profile, the American College of Cardiology and American Heart Association classify a risk score of 10–20 percent as high risk, potentially necessitating preventive treatment,” commented the researchers. “The proposed risk score is clinically useful because it adequately identifies patients with moderate-to-high ASCVD risk.”