Background The Framingham Risk Score (FRS) and the Pooled Cohort Equations (PCE) are established tools for the prediction of cardiovascular disease (CVD) risk. In the Western world, decreases in incidence rates of CVD were observed over the last 30 years. Thus, we hypothesise that there are also temporal trends in the risk prediction performance of the FRS and PCE from 1990 to 2000.
Methods We used data from n=7789 men and women aged 40–74 years from three prospective population-based cohort studies enrolled in Southern Germany in 1989/1990, 1994/1995 and 1999/2000. 10-year CVD risk was calculated by recalibrated equations of the FRS or PCE. Calibration was evaluated by percentage of overestimation and Hosmer-Lemeshow tests. Discrimination performance was assessed by receiver operating characteristic (ROC) curves and corresponding area under the curve (AUC).
Results Across the three studies, we found significant temporal trends in risk factor distributions and predicted risks by both risk scores (men: 18.0%, 15.4%, 14.9%; women: 8.7%, 11.2%, 10.8%). Furthermore, also the discrimination performance evolved differently for men (AUC PCE: 76.4, 76.1, 72.8) and women (AUC PCE: 75.9, 79.5, 80.5). Both risk scores overestimated actual CVD risk.
Conclusion There are temporal trends in the performance of the FRS and PCE. Although the overall performance remains adequate, sex-specific trends have to be taken into account for further refinement of risk prediction models.
- cardiovascular disease
- longitudinal studies
- medical statistics
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Contributors SR derived the study questions, conducted the statistical analyses and interpretation of results and drafted the manuscript. BT, TdlHG, CM, RH and WK participated substantially in the data acquisition and quality control of the cohort data used for the study, reviewed the manuscript and revised it for important intellectual content. UM contributed substantially to the statistical analyses of the manuscript, reviewed the manuscript and revised it for important intellectual content. AP contributed substantially to the design of the study questions, participated substantially in the data acquisition and quality control of the cohort data used for the study, reviewed the manuscript and revised it for important intellectual content. All authors have approved the final manuscript.
Funding The KORA study was initiated and financed by the Helmholtz Zentrum München – German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education and Research (BMBF) and by the State of Bavaria.
Competing interests None declared.
Patient consent Not required.
Ethics approval The KORA studies were approved by the ethics committee of the Bavarian Chamber of Physicians, Munich. The investigations were carried out in accordance with the Declaration of Helsinki.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The informed consent given by KORA study participants does not cover data posting in public databases. However, data are available upon request from KORA-gen (http://epi.helmholtz-muenchen.de/kora-gen/) by means of a project agreement. Requests should be sent to firstname.lastname@example.org and are subject to approval by the KORA Board.
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