Revised Framingham Stroke Risk Profile to Reflect Temporal Trends

Area of Science:

• Epidemiology
• Cardiovascular Disease Research
• Biostatistics

Background:

• Stroke incidence has declined due to risk factor management.
• The Framingham Stroke Risk Profile (FSRP) requires updating to reflect current risk factor prevalence.
• Evaluating a revised FSRP is crucial for contemporary stroke risk prediction.

Purpose of the Study:

• To compare the predictive accuracy of a standard (old) FSRP with a revised (new) FSRP.
• To validate the new FSRP in external cohorts (3C and REGARDS studies).
• To assess the efficacy of updated FSRP in predicting 5- and 10-year stroke risks.

Main Methods:

• Calculated old and new FSRP models using recent epoch-specific risk factor data.
• Applied models to individuals aged ≥55 and ≥65 years to match external cohort age ranges.
• Compared model performance in predicting stroke risk within the Framingham Heart Study (FHS) and external cohorts.

Main Results:

• The new FSRP demonstrated superior stroke risk prediction compared to the old FSRP across all three samples (FHS, REGARDS, 3C).
• Calibration statistics (χ²) indicated significantly better model fit for the new FSRP in both men and women.
• In the REGARDS study, the new FSRP showed improved prediction accuracy in white participants compared to black participants.

Conclusions:

• The updated FSRP provides a more accurate prediction of current stroke risks in large community samples.
• The revised FSRP can serve as a foundation for investigating geographic and racial disparities in stroke risk.
• This updated tool may facilitate the assessment of novel stroke risk factors.