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Validation of the Framingham general cardiovascular risk score in a multiethnic Asian population: a retrospective
Yook Chin Chia1, Sarah Yu Weng Gray2, Siew Mooi Ching3
1Department of Primary Care Medicine, Faculty of Medicine, University of Malaya Primary Care Research Group (UMPCRG), University of Malaya, Kuala Lumpur, Malaysia.
Insights
The Framingham general cardiovascular disease (CVD) risk score shows moderate accuracy in a Malaysian primary care setting. It performs well for men and multiethnic groups, though it slightly overestimates risk in women.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Cardiovascular disease (CVD) risk prediction is crucial for primary prevention.
- The Framingham general cardiovascular disease (CVD) risk score is widely used globally.
- Validating risk prediction tools in diverse populations is essential.
Purpose of the Study:
- To assess the accuracy of the Framingham general CVD risk score in a Malaysian primary care population.
- To evaluate the score's performance across different ethnic groups and genders.
Main Methods:
- A 10-year retrospective cohort study involving 967 patients from a Malaysian primary care clinic.
- Collected baseline data included demographics, diabetes, smoking, blood pressure, and serum lipids.
- Framingham CVD scores were calculated, and subsequent atherosclerotic CVD events were tracked.
Main Results:
- The Framingham score demonstrated moderate discrimination (AUC 0.63) and good calibration (Hosmer-Lemeshow p=0.78).
- Performance varied by gender, predicting accurately for men but overestimating for women.
- The score showed good discrimination across Malay, Chinese, and Indian ethnic groups.
Conclusions:
- The Framingham general CVD risk score is a reasonable tool for CVD risk prediction in a multiethnic primary care setting in Malaysia.
- Adjustments may be needed for female patients due to potential overestimation.
- Its use is recommended in the absence of locally developed risk prediction charts.
Objective:
This study aims to examine the validity of the Framingham general cardiovascular disease (CVD) risk chart in a primary care setting.
Design:
This is a 10-year retrospective cohort study.
Setting:
A primary care clinic in a teaching hospital in Malaysia.
Participants:
967 patients' records were randomly selected from patients who were attending follow-up in the clinic.
Main Outcome Measures:
Baseline demographic data, history of diabetes and smoking, blood pressure (BP), and serum lipids were captured from patient records in 1998. Each patient's Framingham CVD score was computed from these parameters. All atherosclerotic CVD events occurring between 1998 and 2007 were counted.
Results:
In 1998, mean age was 57 years with 33.8% men, 6.1% smokers, 43.3% diabetics and 59.7% hypertensive. Median BP was 140/80 mm Hg and total cholesterol 6.0 mmol/L (1.3). The predicted median Framingham general CVD risk score for the study population was 21.5% (IQR 1.2-30.0) while the actual CVD events that occurred in the 10 years was 13.1% (127/967). The median CVD points for men was 30.0, giving them a CVD risk of more than 30%; for women it is 18.5, a CVD risk of 21.5%. Our study found that the Framingham general CVD risk score to have moderate discrimination with an area under the receiver operating characteristic curve (AUC) of 0.63. It also discriminates well for Malay (AUC 0.65, p=0.01), Chinese (AUC 0.60, p=0.03), and Indians (AUC 0.65, p=0.001). There was good calibration with Hosmer-Lemeshow test χ(2)=3.25, p=0.78.
Conclusions:
Taking into account that this cohort of patients were already on treatment, the Framingham General CVD Risk Prediction Score predicts fairly accurately for men and overestimates somewhat for women. In the absence of local risk prediction charts, the Framingham general CVD risk prediction chart is a reasonable alternative for use in a multiethnic group in a primary care setting.
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