RT Journal Article
SR Electronic
T1 Calibration and discrimination of the Framingham Risk Score and the Pooled Cohort Equations
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E442
OP E449
DO 10.1503/cmaj.190848
VO 192
IS 17
A1 Dennis T. Ko
A1 Atul Sivaswamy
A1 Maneesh Sud
A1 Gynter Kotrri
A1 Paymon Azizi
A1 Maria Koh
A1 Peter C. Austin
A1 Douglas S. Lee
A1 Idan Roifman
A1 George Thanassoulis
A1 Karen Tu
A1 Jacob A. Udell
A1 Harindra C. Wijeysundera
A1 Todd J. Anderson
YR 2020
UL http://www.cmaj.ca/content/192/17/E442.abstract
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.