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Re-estimation improved the performance of two Framingham cardiovascular risk equations and the Pooled Cohort equations: A nationwide registry analysis

Equations predicting the risk of occurrence of cardiovascular disease (CVD) are used in primary care to identify high-risk individuals among the general population. To improve the predictive performance of such equations, we updated the Framingham general CVD 1991 and 2008 equations and the Pooled C...

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Autores principales: Wallisch, Christine, Heinze, Georg, Rinner, Christoph, Mundigler, Gerald, Winkelmayer, Wolfgang C., Dunkler, Daniela
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235230/
https://www.ncbi.nlm.nih.gov/pubmed/32424214
http://dx.doi.org/10.1038/s41598-020-64629-6
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author Wallisch, Christine
Heinze, Georg
Rinner, Christoph
Mundigler, Gerald
Winkelmayer, Wolfgang C.
Dunkler, Daniela
author_facet Wallisch, Christine
Heinze, Georg
Rinner, Christoph
Mundigler, Gerald
Winkelmayer, Wolfgang C.
Dunkler, Daniela
author_sort Wallisch, Christine
collection PubMed
description Equations predicting the risk of occurrence of cardiovascular disease (CVD) are used in primary care to identify high-risk individuals among the general population. To improve the predictive performance of such equations, we updated the Framingham general CVD 1991 and 2008 equations and the Pooled Cohort equations for atherosclerotic CVD within five years in a contemporary cohort of individuals who participated in the Austrian health-screening program from 2009–2014. The cohort comprised 1.7 M individuals aged 30–79 without documented CVD history. CVD was defined by hospitalization or death from cardiovascular cause. Using baseline and follow-up data, we recalibrated and re-estimated the equations. We evaluated the gain in discrimination and calibration and assessed explained variation. A five-year general CVD risk of 4.61% was observed. As expected, discrimination c-statistics increased only slightly and ranged from 0.73–0.79. The two original Framingham equations overestimated the CVD risk, whereas the original Pooled Cohort equations underestimated it. Re-estimation improved calibration of all equations adequately, especially for high-risk individuals. Half of the individuals were reclassified into another risk category using the re-estimated equations. Predictors in the re-estimated Framingham equations explained 7.37% of the variation, whereas the Pooled Cohort equations explained 5.81%. Age was the most important predictor.
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spelling pubmed-72352302020-05-29 Re-estimation improved the performance of two Framingham cardiovascular risk equations and the Pooled Cohort equations: A nationwide registry analysis Wallisch, Christine Heinze, Georg Rinner, Christoph Mundigler, Gerald Winkelmayer, Wolfgang C. Dunkler, Daniela Sci Rep Article Equations predicting the risk of occurrence of cardiovascular disease (CVD) are used in primary care to identify high-risk individuals among the general population. To improve the predictive performance of such equations, we updated the Framingham general CVD 1991 and 2008 equations and the Pooled Cohort equations for atherosclerotic CVD within five years in a contemporary cohort of individuals who participated in the Austrian health-screening program from 2009–2014. The cohort comprised 1.7 M individuals aged 30–79 without documented CVD history. CVD was defined by hospitalization or death from cardiovascular cause. Using baseline and follow-up data, we recalibrated and re-estimated the equations. We evaluated the gain in discrimination and calibration and assessed explained variation. A five-year general CVD risk of 4.61% was observed. As expected, discrimination c-statistics increased only slightly and ranged from 0.73–0.79. The two original Framingham equations overestimated the CVD risk, whereas the original Pooled Cohort equations underestimated it. Re-estimation improved calibration of all equations adequately, especially for high-risk individuals. Half of the individuals were reclassified into another risk category using the re-estimated equations. Predictors in the re-estimated Framingham equations explained 7.37% of the variation, whereas the Pooled Cohort equations explained 5.81%. Age was the most important predictor. Nature Publishing Group UK 2020-05-18 /pmc/articles/PMC7235230/ /pubmed/32424214 http://dx.doi.org/10.1038/s41598-020-64629-6 Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Article
Wallisch, Christine
Heinze, Georg
Rinner, Christoph
Mundigler, Gerald
Winkelmayer, Wolfgang C.
Dunkler, Daniela
Re-estimation improved the performance of two Framingham cardiovascular risk equations and the Pooled Cohort equations: A nationwide registry analysis
title Re-estimation improved the performance of two Framingham cardiovascular risk equations and the Pooled Cohort equations: A nationwide registry analysis
title_full Re-estimation improved the performance of two Framingham cardiovascular risk equations and the Pooled Cohort equations: A nationwide registry analysis
title_fullStr Re-estimation improved the performance of two Framingham cardiovascular risk equations and the Pooled Cohort equations: A nationwide registry analysis
title_full_unstemmed Re-estimation improved the performance of two Framingham cardiovascular risk equations and the Pooled Cohort equations: A nationwide registry analysis
title_short Re-estimation improved the performance of two Framingham cardiovascular risk equations and the Pooled Cohort equations: A nationwide registry analysis
title_sort re-estimation improved the performance of two framingham cardiovascular risk equations and the pooled cohort equations: a nationwide registry analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235230/
https://www.ncbi.nlm.nih.gov/pubmed/32424214
http://dx.doi.org/10.1038/s41598-020-64629-6
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