Dennis T Ko1, Atul Sivaswamy2, Maneesh Sud2, Gynter Kotrri2, Paymon Azizi2, Maria Koh2, Peter C Austin2, Douglas S Lee2, Idan Roifman2, George Thanassoulis2, Karen Tu2, Jacob A Udell2, Harindra C Wijeysundera2, Todd J Anderson2. 1. Schulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta. dennis.ko@ices.on.ca. 2. Schulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta.
Abstract
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.
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.
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Authors: Dennis T Ko; Tareq Ahmed; Peter C Austin; Warren J Cantor; Paul Dorian; Michael Goldfarb; Yanyan Gong; Michelle M Graham; Jing Gu; Nathaniel M Hawkins; Thao Huynh; Karin H Humphries; Maria Koh; Yoan Lamarche; Laurie J Lambert; Patrick R Lawler; Jean-Francois Légaré; Hung Q Ly; Feng Qiu; Ata Ur Rehman Quraishi; Derek Y So; Robert C Welsh; Harindra C Wijeysundera; Graham Wong; Andrew T Yan; Yana Gurevich Journal: CJC Open Date: 2021-05-01