The Revised Framingham Stroke Risk Profile in a Primary Prevention Population

uring the past few decades, improvements in cardiovascular risk factor control have exerted a significant impact on the incidence of stroke. 1 Recently, the Framingham Stroke Risk Profile (FSRP) to establish a person's 10-year risk of stroke was revised to take into account these changes in the distribution of the risk factors that were included in the original FSRP (ie, blood pressure, smoking, and diabetes mellitus).1 An important notion with regard to this revised FSRP is that it was developed in a mixed population of individuals qualifying for primary prevention of cardiovascular disease (CVD), patients with a history of noncerebrovascular CVD, and patients with a history of atrial fibrillation (AF).Contrary to the 1980s, during which the original FSRP was developed, nowadays, clear guidance is available for risk factor control in patients with a history of CVD, and particularly for patients with AF, the use of other validated stroke risk models are recommended.2 Hence, from a clinical point of view, it would be specifically interesting to determine the predictive ability of the revised FSRP in persons free of CVD and AF: particularly in these individuals, stroke risk estimation could actually affect risk factor management.Hence, the purpose of the current analyses was 2-fold.First, we validated the revised FSRP in 7966 persons free of cerebrovascular disease from the prospective population-based Rotterdam Study 3 and compared the predictive ability with the original FSRP.Second, we investigated the predictive ability of the revised FSRP to assess the 10-year stroke risk in individuals without a history of CVD (defined as coronary heart disease, heart failure, or peripheral vascular disease) or AF.To take into account the temporal trends in stroke incidence and the distribution of stroke risk factors, we restricted our study sample to persons of 55 years of age or older who participated between 2002 and 2006.These participants were followed up for stroke over a 10-year period using standardized validated methods to collect incident stroke events from the participants' medical records and hospital discharge letters.Potential stroke events were adjudicated in consensus meetings led by an experienced stroke neurologist.4 The Rotterdam Study was approved by the Medical Ethics Committee of the Erasmus MC according to the "Population Screening Act: Rotterdam Study" executed by the Ministry of Health, Welfare, and Sports of The Netherlands.All participants provided written informed consent.The mean age of the participants was 69.5 years with 58.9% women (Table ).During 57 819 person-years of follow-up, the incidence rate for stroke was 8.7 per 1000 person-years (95% confidence interval [CI], 7.9-9.5).We found that the revised FSRP performed similar to the original FSRP in terms of discrimination (Cstatistic for women 0.74 (95% CI, 0.72-0.77)using the original FSRP and 0.74 (95% CI, 0.71-0.76)using the revised FSRP; corresponding numbers for men were 0.69 (95% CI, 0.66-0.73)and 0.68 (95% CI, 0.65-0.72),respectively.