Abstract
Background: Cardiovascular disease (CVD) poses a significant health burden in low- and middle-income countries (LMIC), yet existing risk stratification strategies are primarily designed and validated in high-income countries. Objectives: We evaluated the discrimination and calibration of four CVD risk scores - Framingham General Risk (FGR), Pooled Cohort Equations (PCE), World Health Organization CVD score (WHO), and European Society of Cardiology (Score-2) - within the largest Brazilian community-based cohort study (ELSA-Brasil). Methods: We included all individuals aged 40 to 75 years in the prospective ELSA-Brasil without prior CVD who were followed for incident adjudicated CVD events (fatal and non-fatal MI and stroke or CHD death). We compared the mean predicted CVD risk scaled to 4 years with the observed 4-year CVD events across baseline risk groups (<5%, 5-10% and ≥10%.). For the total population and by race/sex group, we assessed discrimination by measuring the area under the ROC curve and calibration by predicted-to-observed risk (P/O) ratios using the Grønnesby-Borgan goodness-of-fit test. Results: 12,742 individuals (52.9±8.1 years, 55.5% female) had 134 events. The model discrimination was acceptable for all scores (AUC>0.7), except for white women (AUC between 0.60 95% CI 0.44-0.76 and 0.64 95% CI 0.51-0.77). All risk scores overestimated the CVD risk in our study population (P/O ratio between 2.29 and 1.15). PCE and FGR scores displayed the highest overestimation (P/O ratio: 2.29 95% CI 2.07-2.51 and 2.19 95% CI 1.88-2.50, respectively), and the recalibrated WHO score for tropical Americas had the best calibration performance (P/O ratio: 1.15 95% CI 0.96-1.34). Conclusion: Current CVD risk scores have good discrimination but poor calibration in this admixed Brazilian population. The recalibrated WHO score showed the best calibration, highlighting the need for improved risk stratification and tailored risk-based prevention strategies in LMICs.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
