title: Cardiovascular risk assessment: addition of CKD and race to the Framingham equation.
abstract: OBJECTIVE
  The value of the Framingham equation in predicting cardiovascular risk in African Americans and patients with chronic kidney disease (CKD) is unclear. The purpose of the study was to evaluate whether the addition of CKD and race to the Framingham equation improves risk stratification in hypertensive patients.
  
  
  METHODS
  Participants in the ALLHAT were studied. Those randomized to doxazosin, older than 74 years, and those with a history of coronary heart disease were excluded. Two risk stratification models were developed using Cox proportional hazards models in a two-thirds developmental sample. The first model included the traditional Framingham risk factors. The second model included the traditional risk factors plus CKD, defined by estimated glomerular filtration rate categories, and stratification by race (black vs non-black). The primary outcome was a composite of fatal coronary heart disease, nonfatal myocardial infarction, coronary revascularization, and hospitalized angina.
  
  
  RESULTS
  There were a total of 19,811 eligible subjects. In the validation cohort, there was no difference in C-statistics between the Framingham equation and the ALLHAT model including CKD and race. This was consistent across subgroups by race and sex and among those with CKD. One exception was among Non-Black women where the C-statistic was higher for the Framingham equation (0.68 vs 0.65, P = .02). In addition, net reclassification improvement was not significant for any subgroup based on race and sex, ranging from -5.5% to 4.4%.
  
  
  CONCLUSIONS
  The addition of CKD status and stratification by race does not improve risk prediction in high-risk hypertensive patients.
authors.affiliation: MetroHealth Medical Center, Cleveland, OH, USA. draw0003@umn.edu
authors.forename: Paul E
authors.initials: PE
authors.lastname: Drawz
authors.forename: Sarah
authors.initials: S
authors.lastname: Baraniuk
authors.forename: Barry R
authors.initials: BR
authors.lastname: Davis
authors.forename: Clinton D
authors.initials: CD
authors.lastname: Brown
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: Colon
authors.forename: Aloysius B
authors.initials: AB
authors.lastname: Cujyet
authors.forename: Richard A
authors.initials: RA
authors.lastname: Dart
authors.forename: James F
authors.initials: JF
authors.lastname: Graumlich
authors.forename: Mario A
authors.initials: MA
authors.lastname: Henriquez
authors.forename: Jamaluddin
authors.initials: J
authors.lastname: Moloo
authors.forename: Mohammed G
authors.initials: MG
authors.lastname: Sakalayen
authors.forename: Debra L
authors.initials: DL
authors.lastname: Simmons
authors.forename: Carol
authors.initials: C
authors.lastname: Stanford
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Sweeney
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Wong
authors.forename: Mahboob
authors.initials: M
authors.lastname: Rahman
mesh_terms: D000787:Angina Pectoris / Q000208:ethnology; D044383:Black People; D015331:Cohort Studies; D003327:Coronary Disease / Q000208:ethnology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000208:ethnology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology; D009204:Myocardial Revascularization; D016016:Proportional Hazards Models; D044469:Racial Groups; D051436:Renal Insufficiency, Chronic / Q000208:ethnology*; D018570:Risk Assessment; D001741:Black or African American