Framingham risk score and alternatives for prediction of coronary heart disease in older adults

Rodondi, Nicolas; Locatelli, Isabella; Aujesky, Drahomir; Butler, Javed; Vittinghoff, Eric; Simonsick, Eleanor; Satterfield, Suzanne; Newman, Anne B.; Wilson, Peter W. F.; Pletcher, Mark J.; Bauer, Douglas C.; Health ABC, Study (2012). Framingham risk score and alternatives for prediction of coronary heart disease in older adults. PLoS ONE, 7(3), e34287. Lawrence, Kans.: Public Library of Science 10.1371/journal.pone.0034287

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Background Guidelines for the prevention of coronary heart disease (CHD) recommend use of Framingham-based risk scores that were developed in white middle-aged populations. It remains unclear whether and how CHD risk prediction might be improved among older adults. We aimed to compare the prognostic performance of the Framingham risk score (FRS), directly and after recalibration, with refit functions derived from the present cohort, as well as to assess the utility of adding other routinely available risk parameters to FRS. Methods Among 2193 black and white older adults (mean age, 73.5 years) without pre-existing cardiovascular disease from the Health ABC cohort, we examined adjudicated CHD events, defined as incident myocardial infarction, CHD death, and hospitalization for angina or coronary revascularization. Results During 8-year follow-up, 351 participants experienced CHD events. The FRS poorly discriminated between persons who experienced CHD events vs. not (C-index: 0.577 in women; 0.583 in men) and underestimated absolute risk prediction by 51% in women and 8% in men. Recalibration of the FRS improved absolute risk prediction, particulary for women. For both genders, refitting these functions substantially improved absolute risk prediction, with similar discrimination to the FRS. Results did not differ between whites and blacks. The addition of lifestyle variables, waist circumference and creatinine did not improve risk prediction beyond risk factors of the FRS. Conclusions The FRS underestimates CHD risk in older adults, particularly in women, although traditional risk factors remain the best predictors of CHD. Re-estimated risk functions using these factors improve accurate estimation of absolute risk.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine

UniBE Contributor:

Rodondi, Nicolas and Aujesky, Drahomir

ISSN:

1932-6203

Publisher:

Public Library of Science

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:36

Last Modified:

16 Nov 2015 10:27

Publisher DOI:

10.1371/journal.pone.0034287

PubMed ID:

22470551

Web of Science ID:

000304489000090

BORIS DOI:

10.7892/boris.14430

URI:

https://boris.unibe.ch/id/eprint/14430 (FactScience: 221407)

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