Validation of the general Framingham Risk Score (FRS), SCORE2, revised PCE and WHO CVD risk scores in an Asian population
Background: Cardiovascular risk prediction models incorporate myriad CVD risk factors. Current prediction models are developed from non-Asian populations, and their utility in other parts of the world is unknown. We validated and compared the performance of CVD risk prediction models in an Asian pop...
Published in: | The Lancet Regional Health - Western Pacific |
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2-s2.0-85150274834 Kasim S.S.; Ibrahim N.; Malek S.; Ibrahim K.S.; Aziz M.F.; Song C.; Chia Y.C.; Ramli A.S.; Negishi K.; Mat Nasir N. Validation of the general Framingham Risk Score (FRS), SCORE2, revised PCE and WHO CVD risk scores in an Asian population 2023 The Lancet Regional Health - Western Pacific 35 10.1016/j.lanwpc.2023.100742 https://www.scopus.com/inward/record.uri?eid=2-s2.0-85150274834&doi=10.1016%2fj.lanwpc.2023.100742&partnerID=40&md5=5059b9858245cae9f293221a0b00da25 Background: Cardiovascular risk prediction models incorporate myriad CVD risk factors. Current prediction models are developed from non-Asian populations, and their utility in other parts of the world is unknown. We validated and compared the performance of CVD risk prediction models in an Asian population. Methods: Four validation groups were extracted from a longitudinal community-based study dataset of 12,573 participants aged ≥18 years to validate the Framingham Risk Score (FRS), Systematic COronary Risk Evaluation 2 (SCORE2), Revised Pooled Cohort Equations (RPCE), and World Health Organization cardiovascular disease (WHO CVD) models. Two measures of validation are examined: discrimination and calibration. Outcome of interest was 10-year risk of CVD events (fatal and non-fatal). SCORE2 and RPCE performances were compared to SCORE and PCE, respectively. Findings: FRS (AUC = 0.750) and RPCE (AUC = 0.752) showed good discrimination in CVD risk prediction. Although FRS and RPCE have poor calibration, FRS demonstrates smaller discordance for FRS vs. RPCE (298% vs. 733% in men, 146% vs. 391% in women). Other models had reasonable discrimination (AUC = 0.706–0.732). Only SCORE2-Low, -Moderate and -High (aged <50) had good calibration (X2 goodness-of-fit, P-value = 0.514, 0.189, 0.129, respectively). SCORE2 and RPCE showed improvements compared to SCORE (AUC = 0.755 vs. 0.747, P-value <0.001) and PCE (AUC = 0.752 vs. 0.546, P-value <0.001), respectively. Almost all risk models overestimated 10-year CVD risk by 3%–1430%. Interpretation: In Malaysians, RPCE are evaluated be the most clinically useful to predict CVD risk. Additionally, SCORE2 and RPCE outperformed SCORE and PCE, respectively. Funding: This work was supported by the Malaysian Ministry of Science, Technology, and Innovation (MOSTI) (Grant No: TDF03211036). © 2023 The Author(s) Elsevier Ltd 26666065 English Article All Open Access; Green Open Access |
author |
Kasim S.S.; Ibrahim N.; Malek S.; Ibrahim K.S.; Aziz M.F.; Song C.; Chia Y.C.; Ramli A.S.; Negishi K.; Mat Nasir N. |
spellingShingle |
Kasim S.S.; Ibrahim N.; Malek S.; Ibrahim K.S.; Aziz M.F.; Song C.; Chia Y.C.; Ramli A.S.; Negishi K.; Mat Nasir N. Validation of the general Framingham Risk Score (FRS), SCORE2, revised PCE and WHO CVD risk scores in an Asian population |
author_facet |
Kasim S.S.; Ibrahim N.; Malek S.; Ibrahim K.S.; Aziz M.F.; Song C.; Chia Y.C.; Ramli A.S.; Negishi K.; Mat Nasir N. |
author_sort |
Kasim S.S.; Ibrahim N.; Malek S.; Ibrahim K.S.; Aziz M.F.; Song C.; Chia Y.C.; Ramli A.S.; Negishi K.; Mat Nasir N. |
title |
Validation of the general Framingham Risk Score (FRS), SCORE2, revised PCE and WHO CVD risk scores in an Asian population |
title_short |
Validation of the general Framingham Risk Score (FRS), SCORE2, revised PCE and WHO CVD risk scores in an Asian population |
title_full |
Validation of the general Framingham Risk Score (FRS), SCORE2, revised PCE and WHO CVD risk scores in an Asian population |
title_fullStr |
Validation of the general Framingham Risk Score (FRS), SCORE2, revised PCE and WHO CVD risk scores in an Asian population |
title_full_unstemmed |
Validation of the general Framingham Risk Score (FRS), SCORE2, revised PCE and WHO CVD risk scores in an Asian population |
title_sort |
Validation of the general Framingham Risk Score (FRS), SCORE2, revised PCE and WHO CVD risk scores in an Asian population |
publishDate |
2023 |
container_title |
The Lancet Regional Health - Western Pacific |
container_volume |
35 |
container_issue |
|
doi_str_mv |
10.1016/j.lanwpc.2023.100742 |
url |
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85150274834&doi=10.1016%2fj.lanwpc.2023.100742&partnerID=40&md5=5059b9858245cae9f293221a0b00da25 |
description |
Background: Cardiovascular risk prediction models incorporate myriad CVD risk factors. Current prediction models are developed from non-Asian populations, and their utility in other parts of the world is unknown. We validated and compared the performance of CVD risk prediction models in an Asian population. Methods: Four validation groups were extracted from a longitudinal community-based study dataset of 12,573 participants aged ≥18 years to validate the Framingham Risk Score (FRS), Systematic COronary Risk Evaluation 2 (SCORE2), Revised Pooled Cohort Equations (RPCE), and World Health Organization cardiovascular disease (WHO CVD) models. Two measures of validation are examined: discrimination and calibration. Outcome of interest was 10-year risk of CVD events (fatal and non-fatal). SCORE2 and RPCE performances were compared to SCORE and PCE, respectively. Findings: FRS (AUC = 0.750) and RPCE (AUC = 0.752) showed good discrimination in CVD risk prediction. Although FRS and RPCE have poor calibration, FRS demonstrates smaller discordance for FRS vs. RPCE (298% vs. 733% in men, 146% vs. 391% in women). Other models had reasonable discrimination (AUC = 0.706–0.732). Only SCORE2-Low, -Moderate and -High (aged <50) had good calibration (X2 goodness-of-fit, P-value = 0.514, 0.189, 0.129, respectively). SCORE2 and RPCE showed improvements compared to SCORE (AUC = 0.755 vs. 0.747, P-value <0.001) and PCE (AUC = 0.752 vs. 0.546, P-value <0.001), respectively. Almost all risk models overestimated 10-year CVD risk by 3%–1430%. Interpretation: In Malaysians, RPCE are evaluated be the most clinically useful to predict CVD risk. Additionally, SCORE2 and RPCE outperformed SCORE and PCE, respectively. Funding: This work was supported by the Malaysian Ministry of Science, Technology, and Innovation (MOSTI) (Grant No: TDF03211036). © 2023 The Author(s) |
publisher |
Elsevier Ltd |
issn |
26666065 |
language |
English |
format |
Article |
accesstype |
All Open Access; Green Open Access |
record_format |
scopus |
collection |
Scopus |
_version_ |
1818940558972813312 |