Key result
Adding stroke to the risk stratification outcome cluster resulted in a 10-year risk of 21.98% compared to 14.20% for MI or CHD death alone (absolute difference 7.78%; 95% CI 5.86-9.75).
Why the study?
Does adding stroke to the Framingham CHD risk score outcome cluster increase the estimated 10-year risk of vascular events in individuals free of vascular disease?
Cohort (n=2,613)
Does adding stroke to the Framingham CHD risk score outcome cluster increase the estimated 10-year risk of vascular events in individuals free of vascular disease?
Adding stroke to the Framingham CHD risk score outcome significantly increases estimated 10-year risk, potentially reclassifying patients across the >20% threshold for primary prevention therapies like statins.
May reclassify intermediate-risk patients above statin thresholds; leaves open optimal composite vascular risk scoring in multi-ethnic cohorts.
BACKGROUND AND PURPOSE: The Framingham coronary heart disease (CHD) risk score estimates 10-year risk of myocardial infarction (MI) and CHD death. Because preventive approaches to CHD and stroke are similar, a composite outcome may be more appropriate. We compared 10-year risk of (1) MI or CHD death; and (2) stroke, MI, or CHD death among individuals free of vascular disease. METHODS: The Northern Manhattan Study contains a prospective, population-based study of stroke- and CHD-free individuals≥40 years of age followed for a median of 10 years for vascular events. Framingham coronary heart disease risk score was calculated for each individual and for each category of predicted risk, Kaplan-Meier observed 10-year cumulative probabilities were calculated for (1) MI or CHD death; and (2) stroke, MI, or CHD death. The cumulative probability of (1) was subtracted from (2), and 95% CIs for the difference were obtained with 1000 bootstrap samples. Using stratified analyses by race-ethnicity, we compared risk differences among race-ethnic groups. RESULTS: Among 2613 participants (53% Hispanic, 25% non-Hispanic black, and 20% non-Hispanic white), observed 10-year risk of MI or CHD death was 14.20%. With stroke in the outcome, observed risk was 21.98% (absolute risk difference, 7.78%; 95% CI, 5.86% to 9.75%). The absolute risk difference among blacks was significantly larger than among whites (P=0.01). CONCLUSIONS: In this multiethnic urban population, adding stroke to the risk stratification outcome cluster resulted in a 55% relative increase in estimated risk and crossing of the absolute risk threshold (>20% over 10 years) considered for preventive treatments such as statins.
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Dhamoon et al. (2011) conducted a cohort in Free of vascular disease (n=2,613). Composite outcome of stroke, MI, or CHD death vs. Outcome of MI or CHD death alone was evaluated on 10-year cumulative probability of stroke, MI, or CHD death versus MI or CHD death alone (absolute risk difference 7.78%, 95% CI 5.86-9.75). Adding stroke to the risk stratification outcome cluster resulted in a 10-year risk of 21.98% compared to 14.20% for MI or CHD death alone (absolute difference 7.78%; 95% CI 5.86-9.75).
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