title: New Pooled Cohort Risk equations: application to a recent stroke patient population.
abstract: BACKGROUND
  Recently, Pooled Cohort Risk (PCR) equations, which incorporate new sex- and race-specific estimates of the 10-year risk for atherosclerotic cardiovascular disease (ASCVD) including stroke, for ASCVD-free adults were introduced. Given the importance of secondary stroke prevention and benefit of a potential tool to readily identify stroke patients at high intermediate-term vascular risk for appropriate treatment, we evaluated the prediction and discrimination of the PCR and Framingham Cardiovascular Risk (FCR) equations after a recent stroke.
  
  
  METHODS
  We conducted an analysis of Vitamin Intervention for Stroke Prevention dataset of 3555 recent non-cardioembolic stroke patients aged ≥ 35 years and followed for 2 years. Subjects were categorized as having low-PCR/low-FCR (<20%), high-PCR/high-FCR (≥ 20%), and known-ASCVD. Independent associations of high-PCR/high-FCR with recurrent stroke (primary outcome) and stroke/coronary heart disease (CHD)/vascular death (secondary outcomes) were assessed.
  
  
  RESULTS
  Both PCR and FCR were independently related to both outcomes: compared with low-PCR, high-PCR was associated with stroke (adjusted hazard ratio, 1.79; 95% CI, 1.25-2.57) and stroke/CHD/vascular death (2.05; 1.55-2.70). Compared with low-FCR, high-FCR was associated with stroke (2.06; 1.34-3.16) and stroke/CHD/vascular death (1.57; 1.12-2.20). The c-statistic of PCR/FCR as a continuous variable for stroke was 0.56 (95% CI, 0.54-0.58) and 0.56 (0.54-0.57), respectively and for stroke/CHD/vascular death was 0.62 (0.60-0.63) and 0.61 (0.59-0.63), respectively.
  
  
  CONCLUSIONS
  Both PCR and FCR are significant predictors of recurrent vascular events among patients after a recent non-cardioembolic stroke, but neither one of them is an optimal model for discriminating intermediate-term ASCVD prediction among stroke patients already receiving secondary stroke prevention.
authors.affiliation: Department of Neurology, Myongji Hospital, Goyang, South Korea; Department of Neurosciences, Medical University of South Carolina, Charleston, SC, United States.
authors.forename: Jong-Ho
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Neurology, SMG-SNU Boramae Medical Center, Seoul, South Korea.
authors.forename: Hyung-Min
authors.initials: HM
authors.lastname: Kwon
authors.affiliation: Department of Neurosciences, Medical University of South Carolina, Charleston, SC, United States. Electronic address: Ovibes@musc.edu.
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000453:epidemiology*; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D015991:Epidemiologic Measurements; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D018570:Risk Assessment; D020521:Stroke / Q000453:epidemiology*
keywords: Atherosclerosis; Cardiovascular; Coronary heart disease; Outcome; Stroke; Vascular death