Recalibration of Framingham Risk Score for predicting 10-year cardiovascular disease risk in a South Indian population

Abstract

Background: Cardiovascular diseases (CVDs) are the leading cause of mortality in India. Guidelines recommend using tools, such as the Framingham Risk Score (FRS), to predict the 10-year CVD risk of adults for primary prevention of CVDs. However, FRS was developed based on data from a predominantly White population in the United States, limiting its applicability to other regions. Objectives: This study aimed to recalibrate the FRS equations among adults in Kerala, India. Materials and Methods: Baseline survey data from the Kerala Diabetes Prevention Program were analyzed: 921 males and 567 females for lipid-based FRS scores and 1042 males and 646 females for body mass index (BMI)-based FRS scores. Recalibration of the original FRS scores was performed using local data on CVD risk factors and CVD mortality. Results: Among males, the median 10-year CVD risk with the recalibrated lipid-based FRS score was 7.34 (interquartile ranges [IQR] 4.33–12.42), compared with the original score of 8.88 (5.23–14.87) (P < 0.001). For BMI-based FRS scores, the median 10-year CVD risk was 7.40 (4.27–11.83) for the recalibrated score, compared with 9.32 (5.40–14.80) for the original score (P < 0.001). In females, the median 10-year CVD risk was 4.83 (2.90–8.36) for the recalibrated score, compared with 2.85 (IQR 1.71–4.98) for the original score (P < 0.001). Similarly, the median 10-year CVD risk was 4.66 (2.74–8.81) for the recalibrated BMI-based FRS score, compared for 2.95 (1.72–5.61) with the original score (P < 0.001). Conclusion: Recalibrated FRS scores estimated a significantly lower 10-year CVD risk in males and a higher risk in females than the original FRS scores.

Keywords

• cardiovascular disease; framingham risk score; prediction; recalibration; risk factors