title: Framingham risk score with cardiovascular events in chronic kidney disease.
abstract: The Framingham Risk Score (FRS) was developed to predict coronary heart disease in various populations, and it tended to under-estimate the risk in chronic kidney disease (CKD) patients. Our objectives were to determine whether FRS was associated with cardiovascular events, and to evaluate the role of new risk markers and echocardiographic parameters when they were added to a FRS model. This study enrolled 439 CKD patients. The FRS is used to identify individuals categorically as "low" (<10% of 10-year risk), "intermediate" (10-20% risk) or "high" risk (≥ 20% risk). A significant improvement in model prediction was based on the -2 log likelihood ratio statistic and c-statistic. "High" risk (v.s. "low" risk) predicts cardiovascular events either without (hazard ratios [HR] 2.090, 95% confidence interval [CI] 1.144 to 3.818) or with adjustment for clinical, biochemical and echocardiographic parameters (HR 1.924, 95% CI 1.008 to 3.673). Besides, the addition of albumin, hemoglobin, estimated glomerular filtration rate, proteinuria, left atrial diameter >4.7 cm, left ventricular hypertrophy or left ventricular ejection fraction<50% to the FRS model significantly improves the predictive values for cardiovascular events. In CKD patients, "high" risk categorized by FRS predicts cardiovascular events. Novel biomarkers and echocardiographic parameters provide additional predictive values for cardiovascular events. Future study is needed to assess whether risk assessment enhanced by using these biomarkers and echocardiographic parameters might contribute to more effective prediction and better care for patients.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Szu-Chia
authors.initials: SC
authors.lastname: Chen
authors.forename: Ho-Ming
authors.initials: HM
authors.lastname: Su
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Tsai
authors.forename: Jiun-Chi
authors.initials: JC
authors.lastname: Huang
authors.forename: Jer-Ming
authors.initials: JM
authors.lastname: Chang
authors.forename: Shang-Jyh
authors.initials: SJ
authors.lastname: Hwang
authors.forename: Hung-Chun
authors.initials: HC
authors.lastname: Chen
mesh_terms: D000704:Analysis of Variance; D015415:Biomarkers; D002318:Cardiovascular Diseases / Q000209:etiology*; D004452:Echocardiography / Q000379:methods; D006801:Humans; D016013:Likelihood Functions; D008954:Models, Biological; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012107:Research Design; D018570:Risk Assessment / Q000379:methods*; D013624:Taiwan
chemical_list: D015415:Biomarkers