Key result
Non-laboratory Framingham risk score shows substantial agreement with lab-based tool at ~0.70 kappa.
Why the study?
Cardiovascular risk-prediction models are efficient primary prevention tools, but their agreement in estimating 10-year CVD risk needed evaluation in an Iranian adult population.
Does the Non-Laboratory-Based Framingham Risk Score agree with the Laboratory-Based Framingham Risk Score and WHO/ISH chart in predicting 10-year cardiovascular disease risk in an Iranian population?
Cross-Sectional (n=8,569)
No
Does the Non-Laboratory-Based Framingham Risk Score agree with the Laboratory-Based Framingham Risk Score and WHO/ISH chart in predicting 10-year cardiovascular disease risk in an Iranian population?
Effect estimate: Kappa = 0.70
The Non-Laboratory-Based Framingham Risk Score shows substantial agreement with the Laboratory-Based model and can serve as a primary screening tool in resource-limited settings.
Substantial NLB-FRS agreement with lab-based model may aid screening where labs unavailable; leaves open need for prospective validation before adoption.
Background and aim: Cardiovascular risk-prediction models are efficient primary prevention tools to detect high-risk individuals. The study aims to use three tools to estimate the 10-year risk of developing cardiovascular disease (CVD) and investigate their agreement in an Iranian adult population. Methods: The current cross-sectional study was carried out on 8569 adults between 35 and 70 who participated in the first phase of the Shahedieh cohort study in Yazd, Iran, and were free of CVDs (cardiac ischemia or myocardial infarction or stroke). World Health Organization/International Society of Hypertension (WHO/ISH) chart, Laboratory-Based (LB) and Non-Laboratory-Based (NLB) Framingham Risk Score (FRS) were used to predict the 10-year risk of developing CVD. The agreement across tools was determined by Kappa. Results: WHO/ISH chart indicated the highest prevalence of low CVD risk for males (96.10%) and females (96.50%), while NLB Framingham had the highest prevalence of high CVD risk for males (19.40%) and females (5.30%). In total, there was substantial agreement between both FRS models (Kappa = o.70), while there was a slight agreement between WHO/ISH and both FRS tools. For under 60 years males and females, substantial agreements were observed between FRS methods (kappa = 0.73 and kappa = 0.68). For males and females over 60 years, this agreement was moderate and substantial, respectively (kappa = 0.54 and kappa = 0.64). WHO/ISH and LB Framingham model had substantial agreement for over 60 years females (kappa = 0.61). Conclusions: Framingham models classified more participants in the high-risk category than WHO/ISH. Due to the lethality of CVDs, categorizing individuals based on FRS can ensure that most of the real high-risk people are detected. Remarkable agreement between FRS methods in all sex-age groups suggested using the NLB Framingham model as a primary screening tool, especially in a shortage of resources condition.
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Momayyezi et al. (2023) conducted a cross-sectional in Cardiovascular disease risk (n=8,569). Non-Laboratory-Based (NLB) Framingham Risk Score vs. Laboratory-Based (LB) Framingham Risk Score and WHO/ISH chart was evaluated on Agreement between 10-year CVD risk assessment tools (Kappa = 0.70). The Non-Laboratory-Based Framingham Risk Score showed substantial agreement with the Laboratory-Based model (Kappa = 0.70), suggesting its utility as a primary screening tool in resource-limited settings.
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