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. 2022 Apr 12;12(4):965.
doi: 10.3390/diagnostics12040965.

Validation of the 30-Year Framingham Risk Score in a German Population-Based Cohort

Susanne Rospleszcz  1   2   3 , Fabian Starnecker  3   4 , Birgit Linkohr  2 , Moritz von Scheidt  3   4 , Christian Gieger  2   5 , Heribert Schunkert  3   4 , Annette Peters  1   2   3 ; DigiMed Bayern Consortium
Affiliations

Validation of the 30-Year Framingham Risk Score in a German Population-Based Cohort

Susanne Rospleszcz et al. Diagnostics (Basel). .

Abstract

The Framingham Risk Score to predict 30-year risk (FRS30y) of cardiovascular disease (CVD) constitutes an important tool for long-term risk prediction. However, due to its complex statistical properties and the paucity of large population-based cohorts with appropriate data, validation of the FRS30y is lacking. A population-based cohort from Southern Germany (N = 3110, 1516 (48.7%) women) was followed up for a median time of 29.5 [18.7, 31.2] years. Discrimination and calibration were assessed for the original, recalibrated and refitted FRS30y version. During follow up, 620 incident CVD events (214 in women) occurred. The FRS30y showed adequate discrimination (original and recalibrated version: Area under the curve (AUC): 78.4 for women and 74.9 for men) but overestimated actual CVD risk (original version: discordance 45.4% for women and 37.3% for men, recalibrated version: 37.6% and 28.6%, respectively). Refitting showed substantial improvement in neither discrimination nor calibration. The performance of FRS30y is adequate for long-term CVD risk prediction and could serve as an important tool in risk communication, especially for younger audiences.

Keywords: calibration; cardiovascular disease; cohort study; risk factors; risk prediction.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flowchart of participants.
Figure 2
Figure 2
Survival (time free of fatal or non-fatal CVD event) in different risk strata. Shown are Kaplan-Meier curves for risk groups defined by different thresholds (10%, 25%, 50%) of the recalibrated FRS30y. Censored events (competing events or drop-out) are marked by vertical lines.
Figure 3
Figure 3
Discrimination and calibration performance of FRS30y for women and men. (A) upper row: ROC curves with Area Under the Curve (AUC) as measure of discrimination. As discrimination performance is not affected by recalibration, AUC values for original and recalibrated version are identical and thus the original version is not plotted. (B) lower row: smooth calibration based on LOESS.
See this image and copyright information in PMC

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