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Updated: Jun 26, 2025
05:37
An R-Based Landscape Validation of a Competing Risk Model
Published on: September 16, 2022
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Implications of five different risk models in primary prevention guidelines
Maneesh Sud1,2,3,4, Atul Sivaswamy3, Peter C Austin2,3
1Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, Ontario, M4N3M5, Canada.
Summary
Comparing cardiovascular disease risk models shows newer tools like SCORE2 may better identify high-risk patients for statin therapy. However, older models like the Framingham Risk Score prevent more events overall.
Area of Science:
- Cardiology
- Preventive Medicine
- Health Outcomes Research
Background:
- Guidelines lack consensus on optimal cardiovascular disease (CVD) risk models for primary prevention.
- Risk stratification is crucial for targeted interventions like statin therapy.
Purpose of the Study:
- To compare the effectiveness of different CVD risk models in primary prevention.
- To evaluate potential improvements in Number Needed to Treat (NNT) and Number of Events Prevented (NEP) across models.
Main Methods:
- Retrospective analysis of 47,399 primary care patients (aged 40-75) in Ontario, Canada (2010-2014).
- Risk estimation using Framingham Risk Score (FRS), Pooled Cohort Equations (PCEs), recalibrated FRS (R-FRS), SCORE2, and low-risk region recalibrated SCORE2 (LR-SCORE2).
- Follow-up for up to 5 years to assess CVD events.
Main Results:
- SCORE2 demonstrated the lowest NNT (40) for statin therapy, identifying higher-risk patients more efficiently.
- The Framingham Risk Score (FRS) had the highest NNT (65) but resulted in the highest Number of Events Prevented (NEP) (406).
- Newer models like SCORE2 recommended statins to a smaller proportion of patients (7.9%) compared to FRS (34.6%).
Conclusions:
- Newer risk models, such as SCORE2, may enhance the allocation of statins to higher-risk individuals, indicated by a lower NNT.
- Despite improved targeting, these newer models might prevent fewer overall cardiovascular events at a population level compared to traditional models.
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