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[Performance of equations to predict cardiovascular risk in an Argentine population]
Emanuel J Saad1,2, Malena Finello2, Aldo H Tabares1,3
1Instituto Universitario de Ciencias Biomédicas de Córdoba, Hospital Privado Universitario de Córdoba, Argentina.
Insights
Cardiovascular risk (CVR) prediction in Argentina is uncertain. ATP-III and Pooled Cohort (PC) equations showed acceptable calibration and discrimination for predicting cardiovascular events (CVE) in Argentinian adults.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Assessing cardiovascular risk (CVR) is crucial for primary prevention.
- The accuracy of existing CVR prediction models in diverse populations, like Argentina, is often unknown.
- Validating these tools is essential for effective cardiovascular event (CVE) prevention strategies.
Purpose of the Study:
- To evaluate the performance of multiple cardiovascular risk scores in predicting 10-year CVR and CVE occurrence in an Argentinian population.
- To compare the predictive accuracy and calibration of Framingham 2008, SCORE, ATP III, WHO-American B region, and Pooled Cohort (PC) equations.
- To determine the suitability of these equations for risk stratification in Argentinian adults without prior cardiovascular disease.
Main Methods:
- A prospective cohort study involving 606 Argentinian adults (40-70 years) without known cardiovascular disease.
- Calculation of 10-year CVR using Framingham 2008, SCORE, ATP III, WHO-B, and PC equations.
- Follow-up for 10 years to record fatal myocardial infarction or death from any cause, and non-fatal cardiovascular events (CVE).
- Assessment of model discrimination using Receiver Operating Characteristic (ROC) curves (Area Under Curve - AUC) and calibration using the Hosmer-Lemeshow chi-square test.
Main Results:
- Low observed rates of cardiovascular death (0.8%) and non-fatal CVE (9.8%) over 10 years.
- Framingham 2008, ATP-III, and both PC equations demonstrated acceptable discrimination (AUC > 0.75).
- Only ATP-III and PC equations showed good global calibration (Chi-square < 20 or p > 0.05).
- All tested equations generally overestimated the actual cardiovascular risk in this cohort.
Conclusions:
- The ATP-III and Pooled Cohort (PC) equations exhibit the best performance for predicting cardiovascular risk in the studied Argentinian population.
- Despite overestimation of risk, these models offer a potentially useful tool for cardiovascular risk assessment in Argentinian adults.
- Further validation and potential calibration adjustments may be needed for optimal CVR prediction in this demographic.
Abstract:
The performance of available risk scores to predict cardiovascular risk (CVR) in the Argentinian population is unknown. Our aim was to compare the CVR predicted by several equations with the occurrence of cardiovascular events (CVE) in patients without known cardiovascular disease in an Argentinian hospital. Adults between 40 and 70 years were randomly selected, excluding those with prior history of major CVE, active cancer, lipid lowering treatment and absence of follow-up data. Framingham 2008, SCORE (low and high-risk populations), ATP III, World Health Organization- American B region (WHO-B) and Pooled Cohort equations (PC) risk scores were used to calculate 10-y CVR at time of enrollment. End of follow-up was 10 years ± 6 months, occurrence of fatal myocardial infarction or death from any cause. We used ROC curves to assess discrimination (AUC > 0.75 good discrimination), and Hosmer Lemeshow chi-square to evaluate calibration (Chi > 20 or p value < 0.05 poor calibration). We included 606 patients in our study, 336 women, average age 56.7 ± 8.4 year. Of those, 10 (1.7%) non-cardiovascular deaths, and 5 (0.8%) cardiovascular deaths were observed. 58 (9.8%) a non-fatal CVE were recorded. There was acceptable discrimination for Framingham, ATP-III, and both PC equations. The global calibration was only good with the ATP-III and PC equations. The observed frequency of CVE was low, and the CVR was overestimated by all equations. However, applying ATP-III or PC equations to assess CVR could be considered in our population.
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