Key result
Seven-factor risk score predicts five-year cardiovascular risk in Indigenous Australians with a 0.72 c-statistic.
Why the study?
Current tools have deficiencies for assessing cardiovascular disease risk in Indigenous Australians, a high-risk population.
Does a newly developed 7-factor risk score improve 5-year CVD risk prediction compared to a recalibrated Framingham risk score in remote Indigenous Australians?
Cohort (n=1,583)
Does a newly developed 7-factor risk score improve 5-year CVD risk prediction compared to a recalibrated Framingham risk score in remote Indigenous Australians?
Effect estimate: c-statistic 0.72
p-value: p=0.212
A newly developed seven-factor risk score provides good discrimination and calibration for predicting 5-year CVD risk in remote Indigenous Australians, outperforming the recalibrated Framingham risk score.
May inform CV risk stratification in Indigenous Australians; leaves open prospective validation before clinical adoption.
Background Cardiovascular disease (CVD) is the leading cause of death for Indigenous Australians. There is widespread belief that current tools have deficiencies for assessing CVD risk in this high-risk population. We sought to develop a 5-year CVD risk score using a wide range of known risk factors to further improve CVD risk prediction in this population. Methods We used clinical and demographic information on Indigenous people aged between 30 and 74 years without a history of CVD events who participated in the Well Person's Health Check (WPHC), a community-based survey. Baseline assessments were conducted between 1998 and 2000, and data were linked to administrative hospitalisation and death records for identification of CVD events. We used Cox proportional hazard models to estimate the 5-year CVD risk, and the Harrell's c-statistic and the modified Hosmer-Lemeshow (mH-L) χ 2 statistic to assess the model discrimination and calibration, respectively. Results The study sample consisted of 1,583 individuals (48.1% male; mean age 45.0 year). The risk score consisted of sex, age, systolic blood pressure, diabetes mellitus, waist circumference, triglycerides, and albumin creatinine ratio. The bias-corrected c-statistic was 0.72 and the bias-corrected mH-L χ2 statistic was 12.01 (p-value, 0.212), indicating good discrimination and calibration, respectively. Using our risk score, the CVD risk of the Indigenous Australians could be stratified to a greater degree compared to a recalibrated Framingham risk score. Conclusions A seven-factor risk score could satisfactorily stratify 5-year risk of CVD in an Indigenous Australian cohort. These findings inform future research targeting CVD risk in Indigenous Australians.
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Tran‐Duy et al. (2019) conducted a cohort in Cardiovascular disease risk (n=1,583). Seven-factor CVD risk score vs. Recalibrated Framingham risk score was evaluated on 5-year CVD risk (c-statistic 0.72, p=0.212). A seven-factor risk score demonstrated good discrimination (c-statistic 0.72) and calibration for predicting 5-year cardiovascular risk in Indigenous Australians.
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