Clinical usefulness of the Framingham cardiovascular risk profile beyond its statistical performance: the Tehran...

Area of Science:

• Cardiovascular epidemiology
• Clinical risk prediction
• Public health

Background:

• Risk functions are crucial for clinical practice but often overlooked.
• The Framingham risk function (FRF) is widely used for cardiovascular disease (CVD) risk assessment.
• Evaluating the FRF's clinical utility in diverse populations is essential.

Purpose of the Study:

• To assess the clinical usefulness of the Framingham risk function (FRF) for cardiovascular disease (CVD) in a Middle Eastern population.
• To determine the optimal risk thresholds for applying the FRF in clinical decision-making.
• To compare the FRF's performance with a locally derived risk function.

Main Methods:

• Prospective cohort study of 2,640 men and 3,584 women aged 30-74 years, free of CVD at baseline (1999).
• Calculation of the net benefit fraction for treatment at 10-year risk thresholds of ≥10% and ≥20%.
• Decision curve analysis plotting net benefit fraction against risk thresholds; Kaplan-Meier analysis for incidence estimation.

Main Results:

• Cumulative CVD incidence was 7.6% in women and 12.3% in men.
• The FRF demonstrated good calibration with C-indices of 0.832 (women) and 0.785 (men).
• At a 10% risk threshold, the FRF appropriately identified about 50% of incident CVD cases in both genders; utility decreased significantly at the 20% threshold, especially in women.

Conclusions:

• The Framingham risk function (FRF) is clinically useful for cardiovascular disease risk assessment in this Middle Eastern population, particularly at lower risk thresholds (10%).
• The FRF's utility is comparable to a locally derived function but is less effective at higher thresholds (≥20%), necessitating careful consideration in clinical application.
• Further research may refine risk stratification strategies using the FRF in diverse ethnic groups.