Analysis of three risk stratification systems in a Saudi population

Area of Science:

• Cardiology
• Public Health
• Preventive Medicine

Background:

• Coronary artery disease (CAD) is a leading global cause of mortality.
• Existing cardiovascular risk prediction algorithms lack sufficient validation in the Saudi population.
• Accurate risk assessment is crucial for preventive cardiovascular strategies.

Purpose of the Study:

• To evaluate the predictive accuracy of three major clinical risk score systems for coronary artery disease.
• To assess the validity of the ACC/AHA Pooled Cohort Risk Equation, Framingham Risk Score, and European Systematic Coronary Risk Evaluation in a Saudi cohort.
• To identify the most reliable algorithm for identifying high-risk individuals with excessive coronary calcification in this population.

Main Methods:

• Analysis of clinical data from 462 Saudi patients aged 40 years and above.
• Definition of high-risk coronary artery disease based on Coronary Calcium Score (>400 or ≥75th percentile using Multi-Ethnic Study of Atherosclerosis [MESA] score).
• Calculation and comparison of risk scores using the ACC/AHA, Framingham, and European algorithms.

Main Results:

• 18.8% of patients exhibited coronary calcification, with 13% classified as high risk by MESA score.
• The ACC/AHA equation reclassified 65% of high-risk patients, Framingham 55%, and European 40%.
• Significant differences (p < 0.0001) were observed in risk classification across the algorithms.

Conclusions:

• The ACC/AHA Pooled Cohort Risk Equation demonstrates superior risk calibration compared to the Framingham Risk Score and European Systematic Coronary Risk Evaluation in the Saudi population.
• This finding supports the use of the ACC/AHA equation for more accurate cardiovascular risk assessment in Saudi Arabia.
• Improved risk prediction can enhance targeted preventive interventions for coronary artery disease.