Comparative accuracy of different risk scores in assessing cardiovascular risk in Indians: a study in patients with first myocardial infarction
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Published on: September 26, 2018
Manish Bansal1, Ravi R Kasliwal2, Naresh Trehan3
1Senior Consultant Cardiology, Medanta - The Medicity, Sector 38, Gurgaon 122001, Haryana, India.
Insights
The 3rd Joint British Societies' risk calculator (RiskJBS) identified more Indian patients at high cardiovascular risk than other models. This study highlights the need for validated risk assessment tools for primary prevention in Indian populations.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Existing cardiovascular (CV) risk assessment models lack adequate validation in Indian populations for primary prevention.
- Accurate prediction of 10-year CV event risk is crucial for effective primary prevention strategies.
Purpose of the Study:
- To evaluate the predictive accuracy of four contemporary CV risk assessment models in Indian patients presenting with acute myocardial infarction (MI).
- To compare the performance of Framingham Risk Score (RiskFRS), WHO risk charts (RiskWHO), ACC/AHA equations (RiskACC/AHA), and JBS risk calculator (RiskJBS) in an Indian cohort.
Main Methods:
- Retrospective analysis of 149 Indian patients (mean age 59.4 years, 82.6% males) without prior CV disease who experienced acute MI.
- Application of RiskFRS, RiskWHO, RiskACC/AHA, and RiskJBS to estimate their 10-year CV event risk prior to the MI event.
Main Results:
- RiskWHO provided the lowest risk estimates, with 86.6% of patients predicted <20% 10-year risk.
- RiskFRS and RiskACC/AHA yielded higher risk estimates compared to RiskWHO (p<0.001).
- RiskJBS identified the highest proportion of patients as high-risk (44.1% <20% risk, p<0.01 vs. others).
Conclusions:
- The RiskJBS calculator appears to identify a larger proportion of Indian patients at high cardiovascular risk compared to RiskWHO, RiskFRS, and RiskACC/AHA.
- This study is the first to demonstrate differential performance of these risk models in Indian patients presenting with acute MI.
- Further large-scale prospective studies are necessary to validate these findings and refine risk prediction in India.
Background:
Although a number of risk assessment models are available for estimating 10-year risk of cardiovascular (CV) events in patients requiring primary prevention of CV disease, the predictive accuracy of the contemporary risk models has not been adequately evaluated in Indians.
Methods:
149 patients [mean age 59.4 ± 10.6 years; 123 (82.6%) males] without prior CV disease and presenting with acute myocardial infarction (MI) were included. The four clinically most relevant risk assessment models [Framingham Risk score (RiskFRS), World Health Organization risk prediction charts (RiskWHO), American College of Cardiology/American Heart Association pooled cohort equations (RiskACC/AHA) and the 3rd Joint British Societies' risk calculator (RiskJBS)] were applied to estimate what would have been their predicted 10-year risk of CV events if they had presented just prior to suffering the acute MI.
Results:
RiskWHO provided the lowest risk estimates with 86.6% patients estimated to be having <20% 10-year risk. In comparison, RiskFRS and RiskACC/AHA returned higher risk estimates (61.7% and 69.8% with risk <20%, respectively; p values <0.001 for comparison with RiskWHO). However, the RiskJBS identified the highest proportion of the patients as being at high-risk (only 44.1% at <20% risk, p values 0 < 0.01 for comparison with all the other 3 risk scores).
Conclusions:
This is the first study to show that in Indian patients presenting with acute MI, RiskJBS is likely to identify the largest proportion of the patients as at 'high-risk' as compared to RiskWHO, RiskFRS and RiskACC/AHA. However, large-scale prospective studies are needed to confirm these findings.
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