Abstract
AimTo provide a comprehensive overview of cardiovascular disease (CVD) risk prediction models for women and models that include female-specific predictors.MethodsWe performed a systematic review of CVD risk prediction models for women in the general population by updating a previous review. We searched Medline and Embase up to July 2017 and included studies in which; (a) a new model was developed, (b) an existing model was validated, or (c) a predictor was added to an existing model.ResultsA total of 285 prediction models for women have been developed, of these 160 (56%) were female-specific models, in which a separate model was developed solely in women and 125 (44%) were sex-predictor models. Out of the 160 female-specific models, 2 (1.3%) included one or more female-specific predictors (mostly reproductive risk factors). A total of 591 validations of sex-predictor or female-specific models were identified in 206 papers. Of these, 333 (56%) validations concerned nine models (five versions of Framingham, SCORE, Pooled Cohort Equations and QRISK). The median and pooled C statistics were comparable for sex-predictor and female-specific models. In 260 articles the added value of new predictors to an existing model was described, however in only 3 of these female-specific predictors (reproductive risk factors) were added.ConclusionsThere is an abundance of models for women in the general population. Female-specific and sex-predictor models have similar predictors and performance. Female-specific predictors are rarely included. Further research is needed to assess the added value of female-specific predictors to CVD models for women and provide physicians with a well-performing prediction model for women.
Highlights
Differences between women and men in cardiovascular disease (CVD) have been recognized decades ago [1], pertaining to clinical presentation, pathophysiological mechanisms, course of disease and prognosis [2,3,4,5,6]
There is an abundance of models for women in the general population
As symptoms of CVD are more subtle in women, there is often delayed diagnosis, and treatment and poorer prognosis and outcomes compared with men [7]
Summary
Differences between women and men in cardiovascular disease (CVD) have been recognized decades ago [1], pertaining to clinical presentation, pathophysiological mechanisms, course of disease and prognosis [2,3,4,5,6]. Women and men share many CVD risk factors, which are often used in prediction models for the general population, there are female-specific risk factors. Numerous strategies to reduce the CVD burden have been implemented to identify persons at high risk. As seen in a systematic review published in 2016, over 350 prediction models have been developed in recent years aiming to identify individuals at high CVD risk in the general population [12]. Guidelines in Europe and the Unites States currently recommend the use of Systematic COronary Risk Evaluation (SCORE) or the Pooled Cohort Equations in the general population, both for women and men [13,14]
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