Comparison of the Framingham Risk Score, SCORE and WHO/ISH cardiovascular risk prediction models in an Asian population

• Published in: International journal of cardiology 2014-09, Vol.176 (1), p.211-218
• Main Authors: Selvarajah, Sharmini, Kaur, Gurpreet, Haniff, Jamaiyah, Cheong, Kee Chee, Hiong, Tee Guat, van der Graaf, Yolanda, Bots, Michiel L
• Format: Article
• Language: English
• Subjects: Adult; Aged; Asian Continental Ancestry Group - ethnology; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease prevention; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - ethnology; Cross-Sectional Studies; Female; Follow-Up Studies; Heart; Humans; Hypertension - diagnosis; Hypertension - ethnology; Male; Medical sciences; Middle Aged; Mortality; Population Surveillance - methods; Predictive Value of Tests; Risk Factors; Risk prediction; Risk score; Societies, Medical - standards; Validation; World Health Organization
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2014.07.066

Abstract Background Cardiovascular risk-prediction models are used in clinical practice to identify and treat high-risk populations, and to communicate risk effectively. We assessed the validity and utility of four cardiovascular risk-prediction models in an Asian population of a middle-income country. Methods Data from a national population-based survey of 14,863 participants aged 40 to 65 years, with a follow-up duration of 73,277 person-years was used. The Framingham Risk Score (FRS), SCORE (Systematic COronary Risk Evaluation)-high and -low cardiovascular-risk regions and the World Health Organization/International Society of Hypertension (WHO/ISH) models were assessed. The outcome of interest was 5-year cardiovascular mortality. Discrimination was assessed for all models and calibration for the SCORE models. Results Cardiovascular risk factors were highly prevalent; smoking 20%, obesity 32%, hypertension 55%, diabetes mellitus 18% and hypercholesterolemia 34%. The FRS and SCORE models showed good agreement in risk stratification. The FRS, SCORE-high and -low models showed good discrimination for cardiovascular mortality, areas under the ROC curve (AUC) were 0.768, 0.774 and 0.775 respectively. The WHO/ISH model showed poor discrimination, AUC = 0.613. Calibration of the SCORE-high model was graphically and statistically acceptable for men ( χ2 goodness-of-fit, p = 0.097). The SCORE-low model was statistically acceptable for men ( χ2 goodness-of-fit, p = 0.067). Both SCORE-models underestimated risk in women (p < 0.001). Conclusions The FRS and SCORE-high models, but not the WHO/ISH model can be used to identify high cardiovascular risk in the Malaysian population. The SCORE-high model predicts risk accurately in men but underestimated it in women.