Related Experiment Video
Updated: Dec 21, 2025
Implementation of a Real-Time Psychosis Risk Detection and Alerting System Based on Electronic Health Records using CogStack
Published on: May 15, 2020
Calibration and discrimination of the Framingham Risk Score and the Pooled Cohort Equations
Dennis T Ko1, Atul Sivaswamy2, Maneesh Sud2
1Schulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta. dennis.ko@ices.on.ca.
Insights
The Framingham Risk Score and Pooled Cohort Equations overestimate atherosclerotic cardiovascular disease risk in Ontario. These risk prediction tools need refinement for multiethnic Canadian populations.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Epidemiology
Background:
- Accurate atherosclerotic cardiovascular disease (ASCVD) risk prediction is crucial for primary prevention treatment decisions.
- Existing guidelines recommend the Framingham Risk Score (FRS) and Pooled Cohort Equations (PCE) for ASCVD risk assessment.
- The accuracy of FRS and PCE in a large, contemporary Canadian population has not been previously evaluated.
Purpose of the Study:
- To assess the calibration and discrimination of the FRS and PCE in predicting 5-year ASCVD events.
- To evaluate the accuracy of these risk scores in a large, multiethnic Canadian population in Ontario.
Main Methods:
- An observational study of 84,617 Ontario residents aged 40-79 without prior ASCVD.
- Utilized validated administrative databases to link cholesterol and blood pressure data (2010-2014) with observed ASCVD events over 5 years.
- Compared predicted event rates from FRS and PCE with observed event rates.
Main Results:
- FRS and PCE significantly overpredicted observed ASCVD events (101% and 115% overestimation, respectively).
- Predicted 5-year event rates were 5.78% for FRS and 3.51% for PCE, versus observed rates of 2.6% and 1.4%.
- Discrimination was similar for both scores (C-statistics 0.74 for FRS, 0.73 for PCE), with overestimation varying by age and ethnicity.
Conclusions:
- Current FRS and PCE substantially overestimate ASCVD risk in the Ontario population.
- These findings highlight the need to refine cardiovascular disease risk prediction models for multiethnic Canadian demographics.
- Improved risk assessment tools are necessary for effective primary prevention strategies in Canada.
Background:
Although accurate risk prediction is essential in guiding treatment decisions in primary prevention of atherosclerotic cardiovascular disease, the accuracy of the Framingham Risk Score (recommended by a Canadian guideline) and the Pooled Cohort Equations (recommended by US guidelines) has not been assessed in a large contemporary Canadian population. Our primary objective was to assess the calibration and discrimination of the Framingham Risk Score and Pooled Cohort Equations in Ontario, Canada.
Methods:
We conducted an observational study involving Ontario residents aged 40 to 79 years, without a history of atherosclerotic cardiovascular disease, who underwent cholesterol testing and blood pressure measurement from Jan. 1, 2010, to Dec. 31, 2014. We compared predicted event rates generated by the Framingham Risk Score and the Pooled Cohort Equations with observed event rates at 5 years using linkages from validated administrative databases.
Results:
Our study cohort included 84 617 individuals (mean age 56.3 yr, 56.9% female). Over a maximum follow-up period of 5 years, we observed 2162 (2.6%) events according to the outcome definition of the Framingham Risk Score, and 1224 (1.4%) events according to the outcome definition of the Pooled Cohort Equations. The predicted event rate of 5.78% by the Framingham Risk Score and 3.51% by the Pooled Cohort Equations at 5 years overestimated observed event rates by 101% and 115%, respectively. The degree of overestimation differed by age and ethnicity. The C statistics for the Framingham Risk Score (0.74) and Pooled Cohort Equations (0.73) were similar.
Interpretation:
The Framingham Risk Score and Pooled Cohort Equations significantly overpredicted the actual risks of atherosclerotic cardiovascular disease events in a large population from Ontario. Our finding suggests the need for further refinement of cardiovascular disease risk prediction scores to suit the characteristics of a multiethnic Canadian population.
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:28Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
01:12Relative Risk
01:23Assessment of blood pressure in brachial artery(two-step method)
01:25Strategies for Assessing and Addressing Confounding
Confounding can be addressed at both the design phase of a study and through analytical methods after data...