Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 80, Issue 14, Pages 1330-1342Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2022.07.026
Keywords
prevention; risk; pooled cohorts; statins; Framingham
Categories
Funding
- Canadian Institutes of Health Research [FDN 143313]
- Canadian Institutes of Health Research Foundation [FDN 154333]
- Eliot Phillipson Clinician-Scientist Program at the University of Toronto
- Canadian Institute of Health Research Post Doctoral Fellowship
- SANSAR-Burgundy Young Investigator Award
- Mid-Career Investigator Award from the Heart and Stroke Foundation
- National New Investigator and Ontario Clinician Scientist Awards by the Heart and Stroke Foundation
- Department of Family and Community Medicine at the University of Toronto
- Canada Research Chair in Structural Heart Disease Policy and Outcomes
- Jack Tu Chair in Cardiovascular Outcomes
- Sunnybrook Hospital
- University of Toronto
- Amgen
- Novartis
- Novo Nordisk
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The study aimed to improve risk stratification for statin therapy by recalibrating the Framingham Risk Score and Pooled Cohort Equations using contemporary population-level data. The findings showed that recalibrating the FRS reduced overestimation of risk and improved utilization of statins, while recalibrating the PCEs did not improve the accuracy of risk estimation.
BACKGROUND The Framingham Risk Score (FRS) and Pooled Cohort Equations (PCEs) overestimate risk in many contemporary cohorts. OBJECTIVES This study sought to determine if recalibration of these scores using contemporary population-level data improves risk stratification for statin therapy.METHODS Five-year FRS and PCEs were recalibrated using a cohort of Ontario residents alive January 1, 2011, who were 30 to 79 years of age without cardiovascular disease. Scores were externally validated in a primary care cohort of routinely collected electronic medical record data from January 1, 2010, to December 31, 2014. The relative difference in mean predicted and observed risk, number of statins avoided, and number needed to treat with statins to reduce a cardiovascular event at 5 years were reported.RESULTS The FRS was recalibrated in 6,938,971 Ontario residents (51.6% women, mean age 48 years) and validated in 71,450 individuals (56.1% women, mean age 52 years). Recalibration reduced overestimation from 109% to 49% for women and 131% to 32% for men. The recalibrated FRS was estimated to reduce statin prescriptions in up to 26 per 1,000 low-risk women and 80 per 1,000 low-risk men, as well as reduce the number needed to treat from 61 to 47 in women and from 53 to 41 in men. In contrast, after recalibration of the PCEs, risk remained overestimated by 217% in women and 128% in men.CONCLUSIONS Recalibration is a feasible solution to improve risk prediction but is dependent on the model being used. Recalibration of the FRS but not the PCEs reduced overestimation and may improve utilization of statins. (J Am Coll Cardiol 2022;80:1330-1342) (c) 2022 by the American College of Cardiology Foundation.
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