Calibration and discrimination of the Framingham Risk Score and the Pooled Cohort Equations

Abstract

Accurate individual risk estimation is essential in guiding informed treatment decisions in primary prevention, because treatment has greater benefit in those at increased risk of developing the disease. 1,2 Primary prevention guidelines in cardiology around the world have endorsed the use of risk prediction scores to estimate the risk of atherosclerotic cardiovascular disease as an initial step in assessing the need for preventive treatment. [2][3][4][5][6] The Canadian Cardiovascular Society (CCS) guideline recommends using the Framingham Risk Score to assess risk of atherosclerotic cardiovascular disease. 2 The American College of Cardiology/American Heart Association (ACC/AHA) practice guidelines currently endorse the use of the Pooled Cohort Equations over the Framingham Risk Score for risk estimations. 1,4 Since the Framingham cohort was assembled more than 3 decades ago, there have been substantial declines in the risk of cardiovascular events. 7 Furthermore, these risk scores predict cardiovascular events but do not consider the potential competing impact of noncardiovascular deaths during follow-up. The accuracy of commonly used risk scores has also not been evaluated in a large contemporary Canadian cohort and has not been measured using newer statistical techniques. Our main objective was to assess the calibration and discrimination of the Framingham Risk Score and Pooled Cohort Equations in Ontario, Canada. Second, we aimed to assess the validity of these risk scores in prespecified subgroups to gain additional perspectives. Methods Study design and data sourcesWe performed an observational study of Ontario adults to evalu ate the calibration and discrimination of the Framingham Risk Score and Pooled Cohort Equations using the Electronic RESEARCH

A Machine Learning Model Based on Genetic and Traditional Cardiovascular Risk Factors to Predict Premature Coronary Artery Disease

“…Among the established models, the most widely validated and continuously improved is the Framingham score. This has been applied to predict outcomes for fatal or non-fatal CVD [39,40]. Although the Framingham score is commonly used in the clinic, its predictive accuracy still needs improvement [40].…”

Low-Density Lipoprotein Cholesterol 4: The Notable Risk Factor of Coronary Artery Disease Development

“…Previous researchers (3,33) had made a lot of efforts to assess cardiovascular risk based on known multiple risk factors. The dominant strategy was calculating the total risk score of a person by summing the risk imparted by each of the major risk factors, for example, Framingham risk score and its improved version (34,35). By comparison, our study has some advantages.…”

Development of Acute Myocardial Infarction Mortality and Readmission Models for Public Reporting on Hospital Performance in Canada

“…Discrimination of a prediction model indicates how well it can separate those who do vs do not have an outcome of interest. 28 Using c-statistics as a measure of discrimination, our Canadian AMI mortality model to predict 30-days in-hospital mortality had a c-statistic of 0.834, which represented an improvement compared with existing AMI mortality models used for public reporting, which had a c-statistic of 0.814. 11 Improvement in discrimination was consistently seen in the Ontario data and the national data.…”

“… 25 , 26 Discrimination was assessed by calculating the c-statistic, also commonly known as the area under the receiver operating characteristic curve. 25 , 26 , 27 , 28 Calibration was assessed qualitatively by plotting the predicted and observed risk across the deciles of predicted risk. 25 , 26 , 27 , 28 Multi-collinearity of the variables was assessed using variance inflation factors.…”

“… 25 , 26 , 27 , 28 Calibration was assessed qualitatively by plotting the predicted and observed risk across the deciles of predicted risk. 25 , 26 , 27 , 28 Multi-collinearity of the variables was assessed using variance inflation factors.…”