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Comparison of different cardiovascular risk score calculators for cardiovascular risk prediction and guideline
Naveen Garg1, Subrat K Muduli1, Aditya Kapoor1
1Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Insights
The Framingham Risk Score-Cardiovascular Disease (FRS-CVD) calculator best assesses cardiovascular disease (CVD) risk in Indians. For statin eligibility, the NICE guideline is most appropriate for this population.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Cardiovascular disease (CVD) risk calculators may exhibit varying accuracy in Indian populations compared to others.
- Accurate CVD risk assessment is crucial for preventive strategies, including statin therapy.
Purpose of the Study:
- To compare the performance of multiple CVD risk calculators in an Indian cohort.
- To evaluate statin eligibility based on different international guidelines in Indian patients post-myocardial infarction.
Main Methods:
- 1110 patients with a first myocardial infarction were analyzed.
- CVD risk was calculated using Framingham Risk score-Coronary heart disease (FRS-CHD), Framingham Risk Score-Cardiovascular Disease (FRS-CVD), QRISK2, Joint British Society risk calculator 3 (JBS3), American College of Cardiology/American Heart Association (ACC/AHA), atherosclerotic cardiovascular disease (ASCVD), and WHO risk charts.
- Statin eligibility was assessed using ACC/AHA, NICE, and Canadian guidelines.
Main Results:
- FRS-CVD identified the highest proportion of patients at high CVD risk (51.9%), while WHO and ASCVD performed poorly.
- QRISK2, JBS3, and FRS-CHD showed intermediate performance.
- Statin eligibility varied significantly by guideline: NICE (76%), ACC/AHA (69%), and Canadian (44.6%).
Conclusions:
- FRS-CVD is recommended for CVD risk assessment in Indians, potentially due to its broader outcome prediction.
- The NICE guideline is deemed most appropriate for determining statin eligibility in this population.
Objective:
The accuracy of various 10-year cardiovascular disease (CVD) risk calculators in Indians may not be the same as in other populations. Present study was conducted to compare the various calculators for CVD risk assessment and statin eligibility according to different guidelines.
Methods:
Consecutive 1110 patients who presented after their first myocardial infarction were included. Their CVD risk was calculated using Framingham Risk score- Coronary heart disease (FRS-CHD), Framingham Risk Score- Cardiovascular Disease (FRS-CVD), QRISK2, Joint British Society risk calculator 3 (JBS3), American College of Cardiology/American Heart Association (ACC/AHA), atherosclerotic cardiovascular disease (ASCVD) and WHO risk charts, assuming that they had presented one day before cardiac event for risk assessment. Eligibility for statin uses was also looked into using ACC/AHA, NICE and Canadian guidelines.
Results:
FRS-CVD risk assessment model has performed the best as it could identify the highest number of patients (51.9%) to be at high CVD risk while WHO and ASCVD calculators have performed the worst (only 16.2% and 28.3% patients respectively were stratified into high CVD risk) considering 20% as cut off for high risk definition. QRISK2, JBS3 and FRS-CHD have performed intermediately. Using NICE, ACC/AHA and Canadian guidelines; 76%, 69% and 44.6% patients respectively were found to be eligible for statin use.
Conclusion:
FRS-CVD appears to be the most useful for CVD risk assessment in Indians, but the difference may be because FRS-CVD estimates risk for several additional outcomes as compared with other risk scores. For statin eligibility, however, NICE guideline use is the most appropriate.
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