Performance of Framingham cardiovascular risk scores by ethnic groups in New Zealand: PREDICT CVD-10.

Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand.
The New Zealand medical journal 01/2010; 123(1309):50-61.
Source: PubMed

ABSTRACT To compare the calibration performance of the original Framingham Heart Study risk prediction score for cardiovascular disease and an adjusted version of the Framingham score used in current New Zealand cardiovascular risk management guidelines for high and low risk ethnic groups.
Since 2002 cardiovascular risk assessments have been undertaken as part of routine clinical care in many New Zealand primary care practices using PREDICT, a web-based decision support programme for assessing and managing cardiovascular risk. Individual risk profiles from PREDICT were electronically and anonymously linked to national hospital admissions and death registrations in January 2008. Calibration performance was investigated by comparing the observed 5-year cardiovascular event rates (deaths and hospitalisations) with predicted rates from the Framingham and New Zealand adjusted Framingham scores. Calibration was examined in a combined 'high risk' ethnic group (Maori, Pacific and Indian) and a European 'low risk' ethnic group. There was insufficient person-time follow-up for separate analyses in each ethnic group. The analyses were restricted to PREDICT participants aged 30-74 years with no history of previous cardiovascular disease.
Of the 59,344 participants followed for a mean of 2.11 years (125,064 person years of follow-up), 1,374 first cardiovascular events occurred. Among the 35,240 European participants, 759 cardiovascular events occurred during follow-up, giving a mean observed 5-year cumulative incidence of 4.5%. There were 582 events among the 21,026 Maori, Pacific and Indian participants, corresponding to a mean 5-year cumulative incidence rate of 7.4%. For Europeans, the original Framingham score overestimated 5-year risk by 0.7-3.2% at risk levels below 15% and by about 5% at higher risk levels. In contrast, for Maori, Pacific, and Indian patients combined, the Framingham score underestimated 5-year cardiovascular risk by 1.1-2.2% in participants who scored below 15% 5-year predicted risk (the recommended threshold for drug treatment in New Zealand), and overestimated by 2.4-4.1% the risk in those who scored above the 15% threshold. For both high risk and low risk ethnic groups, the New Zealand adjusted score systematically overestimated the observed 5-year event rate ranging from 0.6-5.3% at predicted risk levels below 15% to 5.4-9.3% at higher risk levels.
The original Framingham Heart Study risk prediction score overestimates risk for the New Zealand European population but underestimates risk for the combined high risk ethnic populations. However the adjusted Framingham score used in New Zealand clinical guidelines overcompensates for this underestimate, resulting in a score that overestimates risk among the European, Maori, Pacific and Indian ethnic populations at all predicted risk levels. When sufficient person years of follow-up are available in the PREDICT cohort, new cardiovascular risk prediction scores should be developed for each of the ethnic groups to allow for more accurate risk prediction and targeting of treatment.

  • Source
    Demographic Research 01/2013; 28(7):207-228. DOI:10.4054/DemRes.2013.28.7 · 1.20 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Existing methods of primary stroke prevention are not sufficiently effective. Based on the recently developed Stroke Riskometer app, a new 'mass-elevated risk stroke/cardiovascular disease prevention' approach as an addition to the currently adopted absolute risk stroke/cardiovascular disease prevention approach is being advocated. We believe this approach is far more appealing to the individuals concerned and could be as efficient as the conventional population-based approach because it allows identification and engagement in prevention of all individuals who are at an increased (even slightly increased) risk of stroke and cardiovascular disease. The key novelty of this approach is twofold. First, it utilizes modern far-reaching mobile technologies, allowing individuals to calculate their absolute risk of stroke within the next 5 to 10 years and to compare their risk with those of the same age and gender without risk factors. Second, it employs self-management strategies to engage the person concerned in stroke/cardiovascular disease prevention, which is tailored to the person's individual risk profile. Preventative strategies similar to the Stroke Riskometer could be developed for other non-communicable disorders for which reliable predictive models and preventative recommendations exist. This would help reduce the burden of non-communicable disorders worldwide.
    International Journal of Stroke 07/2014; 9(5):624-6. DOI:10.1111/ijs.12300 · 4.03 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Vascular dysfunction is associated with onset of cardiovascular disease (CVD). Its effect is reflected as temperature change on the skin. The aim of this work was to test the potential of thermal imaging as cost effective screening tool for prediction of CVD. Thermal imaging of various parts of the subject (N = 80, male/female =44/36, aged 25-75 years) was done using noncontact infrared (IR) camera. In each subject, total cholesterol (TC; mg/dl) and high-density lipoprotein (HDL, mg/dl) were measured according to standard biochemical analysis. Based on National Cholesterol Education Program ATP III criteria, subject with known CVD (N = 16) and age- and sex- matched normal subjects (N = 21) were included in the study. The average surface temperature of various parts from head to toe was calculated and statistical analysis was performed between the groups. In the total population (N = 37), correlation study shows TC (mg/dl) was correlated with measured surface temperature of the following regions: Temporal left (r = -0.316) and right (r = -0.417), neck left (r = 0.347) and right (r = -0.410), and hand left (r = 0.387). HDL (mg/dl) was found to be correlated with measured surface temperature of the following regions: Temporal left (r = 0.445) and right (r = 0.458), hand left (r = -0.470), and foot anterior left (r = -0.332) and right (r = -0.336). Temperature asymmetry was more significant in upper extremity in CVD group. Using the surface temperature, regression models were calculated for noninvasive estimation of TC and HDL. The predictive ability of measured surface temperature for TC and HDL was 60%. The model for noninvasive estimation gave sensitivity and specificity value of 79 and 83% for TC and 78 and 81% for HDL, respectively. Thus, the surface temperature can be one of the screening tools for prediction of CVD. The limitation of the present study is also discussed under future work.
    Journal of Medical Physics 04/2014; 39(2):98-105. DOI:10.4103/0971-6203.131283

Full-text (2 Sources)

Available from
May 22, 2014