title: Comparison of the Framingham Risk Score, SCORE and WHO/ISH cardiovascular risk prediction models in an Asian population.
abstract: BACKGROUND
  Cardiovascular risk-prediction models are used in clinical practice to identify and treat high-risk populations, and to communicate risk effectively. We assessed the validity and utility of four cardiovascular risk-prediction models in an Asian population of a middle-income country.
  
  
  METHODS
  Data from a national population-based survey of 14,863 participants aged 40 to 65 years, with a follow-up duration of 73,277 person-years was used. The Framingham Risk Score (FRS), SCORE (Systematic COronary Risk Evaluation)-high and -low cardiovascular-risk regions and the World Health Organization/International Society of Hypertension (WHO/ISH) models were assessed. The outcome of interest was 5-year cardiovascular mortality. Discrimination was assessed for all models and calibration for the SCORE models.
  
  
  RESULTS
  Cardiovascular risk factors were highly prevalent; smoking 20%, obesity 32%, hypertension 55%, diabetes mellitus 18% and hypercholesterolemia 34%. The FRS and SCORE models showed good agreement in risk stratification. The FRS, SCORE-high and -low models showed good discrimination for cardiovascular mortality, areas under the ROC curve (AUC) were 0.768, 0.774 and 0.775 respectively. The WHO/ISH model showed poor discrimination, AUC=0.613. Calibration of the SCORE-high model was graphically and statistically acceptable for men (χ(2) goodness-of-fit, p=0.097). The SCORE-low model was statistically acceptable for men (χ(2) goodness-of-fit, p=0.067). Both SCORE-models underestimated risk in women (p<0.001).
  
  
  CONCLUSIONS
  The FRS and SCORE-high models, but not the WHO/ISH model can be used to identify high cardiovascular risk in the Malaysian population. The SCORE-high model predicts risk accurately in men but underestimated it in women.
authors: Clinical Research Centre, Kuala Lumpur Hospital, Jalan Pahang, 50586 Kuala Lumpur, Malaysia; Julius Centre University of Malaya, Department of Social and Preventive Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: s.selvarajah@umcutrecht.nl.
authors: Sharmini
authors: S
authors: Selvarajah
authors: Institute for Public Health, Ministry of Health Malaysia, Jalan Bangsar, 50590 Kuala Lumpur, Malaysia.
authors: Gurpreet
authors: G
authors: Kaur
authors: Clinical Research Centre, Kuala Lumpur Hospital, Jalan Pahang, 50586 Kuala Lumpur, Malaysia.
authors: Jamaiyah
authors: J
authors: Haniff
authors: Institute for Medical Research, Ministry of Health Malaysia, Jalan Pahang, 50588 Kuala Lumpur, Malaysia.
authors: Kee Chee
authors: KC
authors: Cheong
authors: Institute for Public Health, Ministry of Health Malaysia, Jalan Bangsar, 50590 Kuala Lumpur, Malaysia.
authors: Tee Guat
authors: TG
authors: Hiong
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Yolanda
authors: Y
authors: van der Graaf
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Michiel L
authors: ML
authors: Bots
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People / Q000208:ethnology*; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000208:ethnology*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D011237:Predictive Value of Tests; D012307:Risk Factors; D012955:Societies, Medical / Q000592:standards*; D014944:World Health Organization
keywords: Cardiovascular disease prevention; Mortality; Risk prediction; Risk score; Validation