Performance of the Framingham and SCORE cardiovascular risk prediction functions in a non-diabetic population of a Spanish health care centre: a validation study

Cañón-Barroso, Lourdes; Muro, Eloísa Cruces; Herrera, Natalio Díaz; Ochoa, Gerardo Fernández; Hueros, Juan Ignacio Calvo; Buitrago, Francisco

doi:10.3109/02813432.2010.518407

Cited by 28 publications

(19 citation statements)

References 30 publications

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“…One Framingham model has previously been validated in six prospective, ethnically diverse cohorts 7 and was shown to have reasonable calibration overall, but prior data specifically for the ATP-III model are sparse. Other, primarily European, investigators have also reported that various versions of Framingham models over-predict CHD incidence, 8,9,35,36 Since clinicians in practice cannot re-calibrate a score for an individual patient, population calibration is essential.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Framingham and Reynolds Risk Scores for Global Cardiovascular Risk Prediction in the Multiethnic Women's Health Initiative

et al. 2012

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Background Framingham-based and Reynolds risk scores for cardiovascular disease (CVD) prediction have not been directly compared in an independent validation cohort. Methods and Results We selected a case-cohort sample of the multi-ethnic Women’s Health Initiative Observational Cohort, comprising 1722 cases of major CVD (752 MIs, 754 ischemic strokes, and 216 other CVD deaths) and a random subcohort of 1994 women without prior CVD. We estimated risk using the ATP-III score, the Reynolds risk score, and the Framingham CVD model, reweighting to reflect cohort frequencies. Predicted 10-year risk varied widely between models, with 10% or higher risk in 6%, 10%, and 41% of women using the ATP-III, Reynolds, and Framingham CVD models, respectively. Calibration was adequate for the Reynolds model, but the ATP-III and Framingham CVD models over-estimated risk for CHD and major CVD, respectively. After recalibration, the Reynolds model demonstrated improved discrimination over the ATP-III model through a higher c-statistic (0.765 vs. 0.757, p=0.03), positive net reclassification improvement (NRI) (4.9%, p=0.02) and positive integrated discrimination improvement (IDI) (4.1%, p<0.0001) overall, excluding diabetics (NRI=4.2%, p=0.01), and in white (NRI=4.3%, p=0.04) and black (NRI=11.4, p=0.13) women. The Reynolds (NRI=12.9, p<0.0001) and ATP-III (NRI=5.9%, p=0.0001) models demonstrated better discrimination than the Framingham CVD model. Conclusions The Reynolds Risk Score was better calibrated than the Framingham-based models in this large external validation cohort. The Reynolds score also showed improved discrimination overall and in black and white women. Large differences in risk estimates exist between models, with clinical implications for statin therapy.

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Section: Discussionmentioning

confidence: 99%

Comparison of the Framingham and Reynolds Risk Scores for Global Cardiovascular Risk Prediction in the Multiethnic Women's Health Initiative

et al. 2012

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“…Despite similarities in estimated outcome, results are conflicting in precision and accuracy. Although some claim the Framingham 10‐year risk calculator to estimate close to the actual observed risk, others state that the Framingham risk model overestimates the risk of CVD, or underestimate it in young women. Previous studies claimed the calculated 10‐ and 30‐years CV risk, based on the Framingham risk calculator to be raised in former PE patients compared to controls .…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular disease risk is only elevated in hypertensive, formerly preeclamptic women

Breetveld

Ghossein‐Doha

Kuijk

et al. 2014

BJOG

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Objective To analyse the predicted 10-and 30-year risk scores for cardiovascular disease (CVD) in patients who experienced preeclampsia (PE) 5-10 years previously compared with healthy parous controls.Design Observational study.Setting Tertiary referral hospital in the Netherlands.Population One hundred and fifteen patients with a history of PE and 50 controls. PE patients were categorised into two groups, hypertensive (n = 21) and normotensive (n = 94), based on use of antihypertensive medication, and next categorised into subgroups based on the onset of PE: early-onset PE (n = 39) and late-onset PE (n = 76).Methods All participants underwent cardiovascular risk screening 5-10 years after index pregnancy. We measured body mass, height and blood pressure. Blood was analysed for fasting glucose, insulin and lipid levels. All participants completed a validated questionnaire. The 10-and 30-year Framingham risk scores were calculated and compared.Main outcome measures Estimated Framingham 10-and 30-year risk scores for CVD.Results The overall 10-and 30-year CVD median risks weighing subjects' lipids were comparable between formerly PE women and controls; 1.6 versus 1.5% (P = 0.22) and 9.0 versus 9.0% (P = 0.49), respectively. However, hypertensive formerly PE women have twice the CVD risk as normotensive formerly PE women: 10-and 30-year CVD median risks were 3.1 versus 1.5% (P < 0.01) and 19.0% versus 8.0% (P < 0.01), respectively. Risk estimates based on BMI rather than lipid profile show comparable results. Early-onset PE clustered more often in the hypertensive formerly PE group and showed significantly higher 10-and 30-year CVD risk estimates based on lipids compared with the lateonset PE group: 1.7 versus 1.3% (P < 0.05) and 10.0 versus 7.0% (P < 0.05), respectively.Conclusions Women who are hypertensive after preeclampsia, have a twofold risk of developing CVD in the next 10-30 years. Formerly PE women who are normotensive in the first 10 years after their preeclamptic pregnancy have a comparable future cardiovascular risk to healthy controls.

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“…This is possibly due to the decline in cardiovascular mortality. This overestimation was reported in many European countries [18-21] but not in all [22,23]. The significant effect of medication on the ΔSCORE probably reflects the direct effect of lipid levels and blood pressure on the parameters included in the calculation of SCORE.…”

Section: Discussionmentioning

confidence: 90%

Which patient and treatment factors are related to successful cardiovascular risk score reduction in general practice? Results from a randomized controlled trial

et al. 2013

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BackgroundCardiovascular disease is a leading cause of death. It is important to identify patient and treatment factors that are related to successful cardiovascular risk reduction in general practice. This study investigates which patient and treatment factors are related to changes in cardiovascular risk estimation, expressed as the Systematic Coronary Risk Evaluation (SCORE) 10 year risk of cardiovascular mortality.Methods179 general practice patients with mild-moderately elevated cardiovascular risk followed a one-year programme which included structured lifestyle and medication treatment by practice nurses, with or without additional self-monitoring. From the patient and treatment data collected as part of the “Self-monitoring and Prevention of RIsk factors by Nurse practitioners in the region of Groningen” randomized controlled trial (SPRING-RCT), the contribution of patient and treatment factors to the change in SCORE was analysed with univariate and multivariate analyses.ResultsIn multivariate analyses with multiple patient and treatment factors, only SCORE at baseline, and addition of or dose change in lipid lowering or antihypertensive medications over the course of the study were significantly related to change in SCORE.ConclusionsOur analyses support the targeting of treatment at individuals with a high SCORE at presentation. Lipid lowering medication was added or changed in only 12% of participants, but nevertheless was significantly related to ΔSCORE in this study population. Due to the effect of medication in this practice-based project, the possible additional effect of the home monitoring devices, especially for individuals with no indication for medication, may have been overshadowed.Trial registrationtrialregister.nl NTR2188

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Performance of the Framingham and SCORE cardiovascular risk prediction functions in a non-diabetic population of a Spanish health care centre: a validation study

Cited by 28 publications

References 30 publications

Comparison of the Framingham and Reynolds Risk Scores for Global Cardiovascular Risk Prediction in the Multiethnic Women's Health Initiative

Comparison of the Framingham and Reynolds Risk Scores for Global Cardiovascular Risk Prediction in the Multiethnic Women's Health Initiative

Cardiovascular disease risk is only elevated in hypertensive, formerly preeclamptic women

Which patient and treatment factors are related to successful cardiovascular risk score reduction in general practice? Results from a randomized controlled trial

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