Validation of the general Framingham Risk Score (FRS), SCORE2, revised PCE and WHO CVD risk scores in an Asian population

• Published in: The Lancet regional health. Western Pacific 2023-06, Vol.35, p.100742-100742, Article 100742
• Main Authors: Kasim, Sazzli Shahlan, Ibrahim, Nurulain, Malek, Sorayya, Ibrahim, Khairul Shafiq, Aziz, Muhammad Firdaus, Song, Cheen, Chia, Yook Chin, Ramli, Anis Safura, Negishi, Kazuaki, Mat Nasir, Nafiza
• Format: Article
• Language: English
• Subjects: Asian; Cardiovascular disease; Revised PCE; Risk prediction model; SCORE2; WHO CVD risk score
• ISSN: 2666-6065; 2666-6065
• DOI: 10.1016/j.lanwpc.2023.100742

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. 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. 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