Cardiovascular Risk Prediction in Postmenopausal Women With and Without Chronic Kidney Disease: An Observational...

Chronic kidney disease (CKD) is an important risk factor for cardiovascular events, yet performance of cardiovascular prediction models are understudied in the CKD population, including women with CKD.

To investigate the performance of multiple cardiovascular prediction models, the Framingham, Adult Treatment Panel (ATP) III, ACC/AHA Pooled Cohort Equations (PCE), QRISK3, and PREVENT models, in women with and without CKD.

Secondary analysis of a prospective cohort study (Women's Health Initiative Biomarker Studies).

21,548 postmenopausal women ages 50-79 without cardiovascular disease, including 1,095 with CKD defined by eGFR < 60 mL/min per 1.73 m².

Model discrimination by C-statistic. Calibration by clinically relevant decision-making thresholds. Included events varied by model: Framingham model outcomes included myocardial infarction (MI), angina, or coronary heart disease (CHD) death; ATP III model outcomes included fatal and nonfatal CHD; PCE and PREVENT model outcomes included CHD or ischemic stroke; QRISK3 model outcomes included CHD, stroke, or transient ischemic attack.

Number of cardiovascular events varied based on outcome definition. For the non-CKD group, events ranged from 846 (4.1%) for ATP III to 1,435 (7.0%) for QRISK3; for the CKD group, events ranged from 93 (8.5%) for ATP III to 145 (13.2%) for QRISK3. Discrimination by C-statistic ranged from 0.57 for the Framingham model to 0.67 for PREVENT in the CKD group; in the non-CKD group, C-statistics ranged from 0.61 for the Framingham model to 0.71 for QRISK3 and PREVENT. Calibration was generally poor in both CKD and non-CKD groups, with underprediction for women with CKD across most models, as well as underprediction for women without CKD for the PREVENT model.

Common cardiovascular risk prediction models have poor discrimination and calibration in women with CKD; the PREVENT model generally underpredicted risk for women with and without CKD.

Not applicable.