PT  - JOURNAL ARTICLE
AU  - Dennis T. Ko
AU  - Atul Sivaswamy
AU  - Maneesh Sud
AU  - Gynter Kotrri
AU  - Paymon Azizi
AU  - Maria Koh
AU  - Peter C. Austin
AU  - Douglas S. Lee
AU  - Idan Roifman
AU  - George Thanassoulis
AU  - Karen Tu
AU  - Jacob A. Udell
AU  - Harindra C. Wijeysundera
AU  - Todd J. Anderson
TI  - Calibration and discrimination of the Framingham Risk Score and the Pooled Cohort Equations
AID  - 10.1503/cmaj.190848
DP  - 2020 Apr 27
TA  - Canadian Medical Association Journal
PG  - E442--E449
VI  - 192
IP  - 17
4099  - http://www.cmaj.ca/content/192/17/E442.short
4100  - http://www.cmaj.ca/content/192/17/E442.full
SO  - CMAJ2020 Apr 27; 192
AB  - BACKGROUND: Although accurate risk prediction is essential in guiding treatment decisions in primary prevention of atherosclerotic cardiovascular disease, the accuracy of the Framingham Risk Score (recommended by a Canadian guideline) and the Pooled Cohort Equations (recommended by US guidelines) has not been assessed in a large contemporary Canadian population. Our primary objective was to assess the calibration and discrimination of the Framingham Risk Score and Pooled Cohort Equations in Ontario, Canada.METHODS: We conducted an observational study involving Ontario residents aged 40 to 79 years, without a history of atherosclerotic cardiovascular disease, who underwent cholesterol testing and blood pressure measurement from Jan. 1, 2010, to Dec. 31, 2014. We compared predicted event rates generated by the Framingham Risk Score and the Pooled Cohort Equations with observed event rates at 5 years using linkages from validated administrative databases.RESULTS: Our study cohort included 84 617 individuals (mean age 56.3 yr, 56.9% female). Over a maximum follow-up period of 5 years, we observed 2162 (2.6%) events according to the outcome definition of the Framingham Risk Score, and 1224 (1.4%) events according to the outcome definition of the Pooled Cohort Equations. The predicted event rate of 5.78% by the Framingham Risk Score and 3.51% by the Pooled Cohort Equations at 5 years overestimated observed event rates by 101% and 115%, respectively. The degree of overestimation differed by age and ethnicity. The C statistics for the Framingham Risk Score (0.74) and Pooled Cohort Equations (0.73) were similar.INTERPRETATION: The Framingham Risk Score and Pooled Cohort Equations significantly overpredicted the actual risks of atherosclerotic cardiovascular disease events in a large population from Ontario. Our finding suggests the need for further refinement of cardiovascular disease risk prediction scores to suit the characteristics of a multiethnic Canadian population.