Journal article
Comparison of the Framingham and Reynolds Risk scores for global cardiovascular risk prediction in the multiethnic Women's Health Initiative
Circulation (New York, N.Y.), Vol.125(14), pp.1748-1756
04/10/2012
DOI: 10.1161/CIRCULATIONAHA.111.075929
PMCID: PMC3324658
PMID: 22399535
Abstract
Framingham-based and Reynolds Risk scores for cardiovascular disease (CVD) prediction have not been directly compared in an independent validation cohort.
We selected a case-cohort sample of the multiethnic Women's Health Initiative Observational Cohort, comprising 1722 cases of major CVD (752 myocardial infarctions, 754 ischemic strokes, and 216 other CVD deaths) and a random subcohort of 1994 women without prior CVD. We estimated risk using the Adult Treatment Panel III (ATP-III) score, the Reynolds Risk Score, and the Framingham CVD model, reweighting to reflect cohort frequencies. Predicted 10-year risk varied widely between models, with ≥10% risk in 6%, 10%, and 41% of women with the ATP-III, Reynolds, and Framingham CVD models, respectively. Calibration was adequate for the Reynolds model, but the ATP-III and Framingham CVD models overestimated risk for coronary heart disease and major CVD, respectively. After recalibration, the Reynolds model demonstrated improved discrimination over the ATP-III model through a higher c statistic (0.765 versus 0.757; P=0.03), positive net reclassification improvement (NRI; 4.9%; P=0.02), and positive integrated discrimination improvement (4.1%; P<0.0001) overall, excluding diabetics (NRI=4.2%; P=0.01), and in white (NRI=4.3%; P=0.04) and black (NRI=11.4%; P=0.13) women. The Reynolds (NRI=12.9%; P<0.0001) and ATP-III (NRI=5.9%; P=0.0001) models demonstrated better discrimination than the Framingham CVD model.
The Reynolds Risk Score was better calibrated than the Framingham-based models in this large external validation cohort. The Reynolds score also showed improved discrimination overall and in black and white women. Large differences in risk estimates exist between models, with clinical implications for statin therapy.
Details
- Title: Subtitle
- Comparison of the Framingham and Reynolds Risk scores for global cardiovascular risk prediction in the multiethnic Women's Health Initiative
- Creators
- Nancy R Cook - Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Ave E, Boston, MA 02215, USA. ncook@rics.bwh.harvard.eduNina P PaynterCharles B EatonJoAnn E MansonLisa W MartinJennifer G RobinsonJacques E RossouwSylvia Wassertheil-SmollerPaul M Ridker
- Resource Type
- Journal article
- Publication Details
- Circulation (New York, N.Y.), Vol.125(14), pp.1748-1756
- DOI
- 10.1161/CIRCULATIONAHA.111.075929
- PMID
- 22399535
- PMCID
- PMC3324658
- NLM abbreviation
- Circulation
- ISSN
- 0009-7322
- eISSN
- 1524-4539
- Publisher
- Lippincott Williams & Wilkins; United States
- Grant note
- N01WH32111 / WHI NIH HHS 32108-9 / PHS HHS 32105-6 / PHS HHS N01WH32115 / WHI NIH HHS HHSN268200960011C / NHLBI NIH HHS N01WH24152 / WHI NIH HHS 42129-32 / PHS HHS 42107-26 / PHS HHS 32118-9 / PHS HHS N01WH44221 / WHI NIH HHS HHSN268200960011C / PHS HHS N01WH32105 / WHI NIH HHS N01WH32118 / WHI NIH HHS 24152 / PHS HHS N01WH42107 / WHI NIH HHS N01WH42129 / WHI NIH HHS N01WH32122 / WHI NIH HHS N01WH32108 / WHI NIH HHS 32122 / PHS HHS 32111-13 / PHS HHS N01WH32100 / WHI NIH HHS 32115 / PHS HHS 44221 / PHS HHS 32100-2 / PHS HHS N01WH22110 / WHI NIH HHS
- Language
- English
- Date published
- 04/10/2012
- Academic Unit
- Epidemiology; Internal Medicine
- Record Identifier
- 9983996085102771
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