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Validation of the Framingham general cardiovascular risk score in a multiethnic Asian population: a retrospective cohort study

OBJECTIVE: This study aims to examine the validity of the Framingham general cardiovascular disease (CVD) risk chart in a primary care setting. DESIGN: This is a 10-year retrospective cohort study. SETTING: A primary care clinic in a teaching hospital in Malaysia. PARTICIPANTS: 967 patients’ records...

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Autores principales: Chia, Yook Chin, Gray, Sarah Yu Weng, Ching, Siew Mooi, Lim, Hooi Min, Chinna, Karuthan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442208/
https://www.ncbi.nlm.nih.gov/pubmed/25991451
http://dx.doi.org/10.1136/bmjopen-2014-007324
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author Chia, Yook Chin
Gray, Sarah Yu Weng
Ching, Siew Mooi
Lim, Hooi Min
Chinna, Karuthan
author_facet Chia, Yook Chin
Gray, Sarah Yu Weng
Ching, Siew Mooi
Lim, Hooi Min
Chinna, Karuthan
author_sort Chia, Yook Chin
collection PubMed
description OBJECTIVE: This study aims to examine the validity of the Framingham general cardiovascular disease (CVD) risk chart in a primary care setting. DESIGN: This is a 10-year retrospective cohort study. SETTING: A primary care clinic in a teaching hospital in Malaysia. PARTICIPANTS: 967 patients’ records were randomly selected from patients who were attending follow-up in the clinic. MAIN OUTCOME MEASURES: Baseline demographic data, history of diabetes and smoking, blood pressure (BP), and serum lipids were captured from patient records in 1998. Each patient's Framingham CVD score was computed from these parameters. All atherosclerotic CVD events occurring between 1998 and 2007 were counted. RESULTS: In 1998, mean age was 57 years with 33.8% men, 6.1% smokers, 43.3% diabetics and 59.7% hypertensive. Median BP was 140/80 mm Hg and total cholesterol 6.0 mmol/L (1.3). The predicted median Framingham general CVD risk score for the study population was 21.5% (IQR 1.2–30.0) while the actual CVD events that occurred in the 10 years was 13.1% (127/967). The median CVD points for men was 30.0, giving them a CVD risk of more than 30%; for women it is 18.5, a CVD risk of 21.5%. Our study found that the Framingham general CVD risk score to have moderate discrimination with an area under the receiver operating characteristic curve (AUC) of 0.63. It also discriminates well for Malay (AUC 0.65, p=0.01), Chinese (AUC 0.60, p=0.03), and Indians (AUC 0.65, p=0.001). There was good calibration with Hosmer-Lemeshow test χ(2)=3.25, p=0.78. CONCLUSIONS: Taking into account that this cohort of patients were already on treatment, the Framingham General CVD Risk Prediction Score predicts fairly accurately for men and overestimates somewhat for women. In the absence of local risk prediction charts, the Framingham general CVD risk prediction chart is a reasonable alternative for use in a multiethnic group in a primary care setting.
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spelling pubmed-44422082015-05-28 Validation of the Framingham general cardiovascular risk score in a multiethnic Asian population: a retrospective cohort study Chia, Yook Chin Gray, Sarah Yu Weng Ching, Siew Mooi Lim, Hooi Min Chinna, Karuthan BMJ Open Cardiovascular Medicine OBJECTIVE: This study aims to examine the validity of the Framingham general cardiovascular disease (CVD) risk chart in a primary care setting. DESIGN: This is a 10-year retrospective cohort study. SETTING: A primary care clinic in a teaching hospital in Malaysia. PARTICIPANTS: 967 patients’ records were randomly selected from patients who were attending follow-up in the clinic. MAIN OUTCOME MEASURES: Baseline demographic data, history of diabetes and smoking, blood pressure (BP), and serum lipids were captured from patient records in 1998. Each patient's Framingham CVD score was computed from these parameters. All atherosclerotic CVD events occurring between 1998 and 2007 were counted. RESULTS: In 1998, mean age was 57 years with 33.8% men, 6.1% smokers, 43.3% diabetics and 59.7% hypertensive. Median BP was 140/80 mm Hg and total cholesterol 6.0 mmol/L (1.3). The predicted median Framingham general CVD risk score for the study population was 21.5% (IQR 1.2–30.0) while the actual CVD events that occurred in the 10 years was 13.1% (127/967). The median CVD points for men was 30.0, giving them a CVD risk of more than 30%; for women it is 18.5, a CVD risk of 21.5%. Our study found that the Framingham general CVD risk score to have moderate discrimination with an area under the receiver operating characteristic curve (AUC) of 0.63. It also discriminates well for Malay (AUC 0.65, p=0.01), Chinese (AUC 0.60, p=0.03), and Indians (AUC 0.65, p=0.001). There was good calibration with Hosmer-Lemeshow test χ(2)=3.25, p=0.78. CONCLUSIONS: Taking into account that this cohort of patients were already on treatment, the Framingham General CVD Risk Prediction Score predicts fairly accurately for men and overestimates somewhat for women. In the absence of local risk prediction charts, the Framingham general CVD risk prediction chart is a reasonable alternative for use in a multiethnic group in a primary care setting. BMJ Publishing Group 2015-05-19 /pmc/articles/PMC4442208/ /pubmed/25991451 http://dx.doi.org/10.1136/bmjopen-2014-007324 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Cardiovascular Medicine
Chia, Yook Chin
Gray, Sarah Yu Weng
Ching, Siew Mooi
Lim, Hooi Min
Chinna, Karuthan
Validation of the Framingham general cardiovascular risk score in a multiethnic Asian population: a retrospective cohort study
title Validation of the Framingham general cardiovascular risk score in a multiethnic Asian population: a retrospective cohort study
title_full Validation of the Framingham general cardiovascular risk score in a multiethnic Asian population: a retrospective cohort study
title_fullStr Validation of the Framingham general cardiovascular risk score in a multiethnic Asian population: a retrospective cohort study
title_full_unstemmed Validation of the Framingham general cardiovascular risk score in a multiethnic Asian population: a retrospective cohort study
title_short Validation of the Framingham general cardiovascular risk score in a multiethnic Asian population: a retrospective cohort study
title_sort validation of the framingham general cardiovascular risk score in a multiethnic asian population: a retrospective cohort study
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442208/
https://www.ncbi.nlm.nih.gov/pubmed/25991451
http://dx.doi.org/10.1136/bmjopen-2014-007324
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