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...

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Published in:The Lancet Regional Health - Western Pacific
Main 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.
Format: Article
Language:English
Published: Elsevier Ltd 2023
Online Access:https://www.scopus.com/inward/record.uri?eid=2-s2.0-85150274834&doi=10.1016%2fj.lanwpc.2023.100742&partnerID=40&md5=5059b9858245cae9f293221a0b00da25
id 2-s2.0-85150274834
spelling 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
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