Cardiovascular risk prediction models for women in the general population: A systematic review

• Published in: PloS one 2019-01, Vol.14 (1), p.e0210329-e0210329
• Main Authors: Baart, Sara J, Dam, Veerle, Scheres, Luuk J J, Damen, Johanna A A G, Spijker, René, Schuit, Ewoud, Debray, Thomas P A, Fauser, Bart C J M, Boersma, Eric, Moons, Karel G M, van der Schouw, Yvonne T
• Format: Article
• Language: English
• Subjects: Analysis; Biology and Life Sciences; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Cohort Studies; Female; Health risk assessment; Health risks; Humans; Mathematical models; Medical personnel; Medicine and Health Sciences; Models, Cardiovascular; Models, Statistical; Performance prediction; Physical Sciences; Physicians; Practice; Prediction models; Research and Analysis Methods; Reviews; Risk analysis; Risk Assessment; Risk Factors; Sex; Sex differences (Biology); Sex Factors; Statistical analysis; Systematic review; Women's health; Womens health
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0210329

To provide a comprehensive overview of cardiovascular disease (CVD) risk prediction models for women and models that include female-specific predictors. We performed a systematic review of CVD risk prediction models for women in the general population by updating a previous review. We searched Medline and Embase up to July 2017 and included studies in which; (a) a new model was developed, (b) an existing model was validated, or (c) a predictor was added to an existing model. A total of 285 prediction models for women have been developed, of these 160 (56%) were female-specific models, in which a separate model was developed solely in women and 125 (44%) were sex-predictor models. Out of the 160 female-specific models, 2 (1.3%) included one or more female-specific predictors (mostly reproductive risk factors). A total of 591 validations of sex-predictor or female-specific models were identified in 206 papers. Of these, 333 (56%) validations concerned nine models (five versions of Framingham, SCORE, Pooled Cohort Equations and QRISK). The median and pooled C statistics were comparable for sex-predictor and female-specific models. In 260 articles the added value of new predictors to an existing model was described, however in only 3 of these female-specific predictors (reproductive risk factors) were added. There is an abundance of models for women in the general population. Female-specific and sex-predictor models have similar predictors and performance. Female-specific predictors are rarely included. Further research is needed to assess the added value of female-specific predictors to CVD models for women and provide physicians with a well-performing prediction model for women.