Framingham risk score and alternatives for prediction of coronary heart disease in older adults

Nicolas Rodondi, Isabella Locatelli, Drahomir Aujesky, Javed Butler, Eric Vittinghoff, Eleanor Marie Simonsick, Suzanne Satterfield, Anne B. Newman, Peter W F Wilson, Mark J. Pletcher, Douglas C. Bauer

Research output: Contribution to journalArticle

Abstract

Background: Guidelines for the prevention of coronary heart disease (CHD) recommend use of Framingham-based risk scores that were developed in white middle-aged populations. It remains unclear whether and how CHD risk prediction might be improved among older adults. We aimed to compare the prognostic performance of the Framingham risk score (FRS), directly and after recalibration, with refit functions derived from the present cohort, as well as to assess the utility of adding other routinely available risk parameters to FRS. Methods: Among 2193 black and white older adults (mean age, 73.5 years) without pre-existing cardiovascular disease from the Health ABC cohort, we examined adjudicated CHD events, defined as incident myocardial infarction, CHD death, and hospitalization for angina or coronary revascularization. Results: During 8-year follow-up, 351 participants experienced CHD events. The FRS poorly discriminated between persons who experienced CHD events vs. not (C-index: 0.577 in women; 0.583 in men) and underestimated absolute risk prediction by 51% in women and 8% in men. Recalibration of the FRS improved absolute risk prediction, particulary for women. For both genders, refitting these functions substantially improved absolute risk prediction, with similar discrimination to the FRS. Results did not differ between whites and blacks. The addition of lifestyle variables, waist circumference and creatinine did not improve risk prediction beyond risk factors of the FRS. Conclusions: The FRS underestimates CHD risk in older adults, particularly in women, although traditional risk factors remain the best predictors of CHD. Re-estimated risk functions using these factors improve accurate estimation of absolute risk.

Original languageEnglish (US)
Article numbere34287
JournalPLoS One
Volume7
Issue number3
DOIs
StatePublished - Mar 28 2012
Externally publishedYes

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Coronary Disease
prediction
coronary disease
risk factors
middle-aged adults
risk estimate
Preexisting Condition Coverage
waist circumference
myocardial infarction
Waist Circumference
creatinine
cardiovascular diseases
lifestyle
Life Style
Creatinine
Hospitalization
Cardiovascular Diseases

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Rodondi, N., Locatelli, I., Aujesky, D., Butler, J., Vittinghoff, E., Simonsick, E. M., ... Bauer, D. C. (2012). Framingham risk score and alternatives for prediction of coronary heart disease in older adults. PLoS One, 7(3), [e34287]. https://doi.org/10.1371/journal.pone.0034287

Framingham risk score and alternatives for prediction of coronary heart disease in older adults. / Rodondi, Nicolas; Locatelli, Isabella; Aujesky, Drahomir; Butler, Javed; Vittinghoff, Eric; Simonsick, Eleanor Marie; Satterfield, Suzanne; Newman, Anne B.; Wilson, Peter W F; Pletcher, Mark J.; Bauer, Douglas C.

In: PLoS One, Vol. 7, No. 3, e34287, 28.03.2012.

Research output: Contribution to journalArticle

Rodondi, N, Locatelli, I, Aujesky, D, Butler, J, Vittinghoff, E, Simonsick, EM, Satterfield, S, Newman, AB, Wilson, PWF, Pletcher, MJ & Bauer, DC 2012, 'Framingham risk score and alternatives for prediction of coronary heart disease in older adults', PLoS One, vol. 7, no. 3, e34287. https://doi.org/10.1371/journal.pone.0034287
Rodondi, Nicolas ; Locatelli, Isabella ; Aujesky, Drahomir ; Butler, Javed ; Vittinghoff, Eric ; Simonsick, Eleanor Marie ; Satterfield, Suzanne ; Newman, Anne B. ; Wilson, Peter W F ; Pletcher, Mark J. ; Bauer, Douglas C. / Framingham risk score and alternatives for prediction of coronary heart disease in older adults. In: PLoS One. 2012 ; Vol. 7, No. 3.
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AU - Vittinghoff, Eric

AU - Simonsick, Eleanor Marie

AU - Satterfield, Suzanne

AU - Newman, Anne B.

AU - Wilson, Peter W F

AU - Pletcher, Mark J.

AU - Bauer, Douglas C.

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N2 - Background: Guidelines for the prevention of coronary heart disease (CHD) recommend use of Framingham-based risk scores that were developed in white middle-aged populations. It remains unclear whether and how CHD risk prediction might be improved among older adults. We aimed to compare the prognostic performance of the Framingham risk score (FRS), directly and after recalibration, with refit functions derived from the present cohort, as well as to assess the utility of adding other routinely available risk parameters to FRS. Methods: Among 2193 black and white older adults (mean age, 73.5 years) without pre-existing cardiovascular disease from the Health ABC cohort, we examined adjudicated CHD events, defined as incident myocardial infarction, CHD death, and hospitalization for angina or coronary revascularization. Results: During 8-year follow-up, 351 participants experienced CHD events. The FRS poorly discriminated between persons who experienced CHD events vs. not (C-index: 0.577 in women; 0.583 in men) and underestimated absolute risk prediction by 51% in women and 8% in men. Recalibration of the FRS improved absolute risk prediction, particulary for women. For both genders, refitting these functions substantially improved absolute risk prediction, with similar discrimination to the FRS. Results did not differ between whites and blacks. The addition of lifestyle variables, waist circumference and creatinine did not improve risk prediction beyond risk factors of the FRS. Conclusions: The FRS underestimates CHD risk in older adults, particularly in women, although traditional risk factors remain the best predictors of CHD. Re-estimated risk functions using these factors improve accurate estimation of absolute risk.

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