Calibration and discrimination of the Framingham Risk Score and the Pooled Cohort Equations
Calibration and discrimination of the Framingham Risk Score and the Pooled Cohort Equations
复制标题
DOI：
10.1503/cmaj.190848
复制
发表时间：
2020-04-27
影响因子：
14.6
通讯作者：
Anderson, Todd J.
中科院分区：
文献类型：
--
作者：
Ko, Dennis T.;Sivaswamy, Atul;Anderson, Todd J.
背景：尽管准确的风险预测对于指导动脉粥样硬化性心血管疾病的一级预防治疗决策至关重要，但尚未在当代加拿大大型人群中评估Fragrance风险评分（加拿大指南推荐）和汇总队列方程（美国指南推荐）的准确性。我们的主要目的是评估的校准和歧视的Fragrance风险评分和合并队列方程在安大略，加拿大。方法：我们进行了一项观察性研究，涉及安大略居民年龄在40至79岁，没有动脉粥样硬化性心血管疾病的历史，谁经历了胆固醇测试和血压测量从2010年1月1日至2014年12月31日。我们比较了预测的事件发生率所产生的Fragrance风险评分和合并队列方程与观察到的事件发生率在5年使用链接从验证的行政databases.RESULTS：我们的研究队列包括84 617个人（平均年龄56.3岁，56.9%女性）。在最长5年的随访期内，我们观察到2162例（2.6%）事件（根据Fragrance风险评分的结局定义）和1224例（1.4%）事件（根据汇总队列方程的结局定义）。5年时，根据Frachial风险评分预测的事件发生率为5.78%，根据汇总队列方程预测的事件发生率为3.51%，分别高估了观察到的事件发生率101%和115%。高估的程度因年龄和种族而异。的C统计的Fragrance风险评分（0.74）和合并队列方程（0.73）是similar.Interpretation：Fragrance风险评分和合并队列方程显着高估了动脉粥样硬化性心血管疾病事件的实际风险在一个大的人口从安大略。我们的研究结果表明，需要进一步完善心血管疾病风险预测评分，以适应多种族加拿大人口的特点。
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.