Performance of cardiovascular risk prediction equations in Indigenous Australians

Abstract

ObjectiveTo assess the performance of cardiovascular disease (CVD) risk equations in Indigenous Australians.MethodsWe conducted an individual participant meta-analysis using longitudinal data of 3618 Indigenous Australians (55% women) aged 30–74 years without CVD from population-based cohorts of the Cardiovascular Risk in IndigenouS People(CRISP) consortium. Predicted risk was calculated using: 1991 and 2008 Framingham Heart Study (FHS), the Pooled Cohorts (PC), GloboRisk and the Central Australian Rural Practitioners Association (CARPA) modification of the FHS equation. Calibration, discrimination and diagnostic accuracy were evaluated. Risks were calculated with and without the use of clinical criteria to identify high-risk individuals.ResultsWhen applied without clinical criteria, all equations, except the CARPA-adjusted FHS, underestimated CVD risk (range of percentage difference between observed and predicted CVD risks: −55% to −14%), with underestimation greater in women (−63% to −13%) than men (−47% to −18%) and in younger age groups. Discrimination ranged from 0.66 to 0.72. The CARPA-adjusted FHS equation showed good calibration but overestimated risk in younger people, those without diabetes and those not at high clinical risk. When clinical criteria were used with risk equations, the CARPA-adjusted FHS algorithm scored 64% of those who had CVD events as high risk; corresponding figures for the 1991-FHS were 58% and were 87% for the PC equation for non-Hispanic whites. However, specificity fell.ConclusionThe CARPA-adjusted FHS CVD risk equation and clinical criteria performed the best, achieving higher combined sensitivity and specificity than other equations. However, future research should investigate whether modifications to this algorithm combination might lead to improved risk prediction.

Randomised clinical trial using Coronary Artery Calcium Scoring in Australian Women with Novel Cardiovascular Risk Factors (CAC-WOMEN Trial): study protocol

“… 39 40 Conventional CVD risk scores can underestimate risk in younger women, and particularly in Aboriginal and Torres Strait Islander women. 14 However, we need to get the balance right—we want to ensure the right women are targeted to receive more intensive preventive pharmacotherapy for CVD.…”

“…39 40 Conventional CVD risk scores can underestimate risk in younger women, and particularly in Aboriginal and Torres Strait Islander women. 14 However, we need to get the balance right-we want to ensure the right women are targeted to receive more intensive preventive pharmacotherapy for CVD. The absence of CAC (CAC=0) confers a <1% 10-year risk of CV death, whereas an abnormal CT-calcium score >1 or >100 confers an approximately fourfold and 10-fold higher risk of CV mortality, respectively.…”

“…This significantly higher risk for CVD in Aboriginal and Torres Strait Islanders is largely driven by a high burden of CVD risk factors at a younger age 39 40. Conventional CVD risk scores can underestimate risk in younger women, and particularly in Aboriginal and Torres Strait Islander women 14. However, we need to get the balance right—we want to ensure the right women are targeted to receive more intensive preventive pharmacotherapy for CVD.…”

“… 11–13 In addition, conventional scores can misclassify risk—and this occurs more often in women than men, particularly Aboriginal and Torres Strait Islander women (Australian Indigenous women) ( figure 1 ). 14 15 On average, CVD events occur 10–20 years earlier in Aboriginal and Torres Strait Islander women, and coronary heart disease is the single largest contributor to the 8-year gap in life expectancy, compared with non-Indigenous women.…”

Performance of the SCORE and Globorisk cardiovascular risk prediction models: a prospective cohort study in Dutch general practice

“…(16)(17)(18)(19) Although some SCORE studies recruited patients from general practice (20)(21)(22)(23)(24) , no study evaluated the real-life use of SCORE by GPs in patients selected by the GP for CVRM. Globorisk has been evaluated in some population-based studies (14,25,26) , but not in general practice.…”