title: Comparative accuracy of different risk scores in assessing cardiovascular risk in Indians: a study in patients with first myocardial infarction.
abstract: BACKGROUND
  Although a number of risk assessment models are available for estimating 10-year risk of cardiovascular (CV) events in patients requiring primary prevention of CV disease, the predictive accuracy of the contemporary risk models has not been adequately evaluated in Indians.
  
  
  METHODS
  149 patients [mean age 59.4 ± 10.6 years; 123 (82.6%) males] without prior CV disease and presenting with acute myocardial infarction (MI) were included. The four clinically most relevant risk assessment models [Framingham Risk score (RiskFRS), World Health Organization risk prediction charts (RiskWHO), American College of Cardiology/American Heart Association pooled cohort equations (RiskACC/AHA) and the 3rd Joint British Societies' risk calculator (RiskJBS)] were applied to estimate what would have been their predicted 10-year risk of CV events if they had presented just prior to suffering the acute MI.
  
  
  RESULTS
  RiskWHO provided the lowest risk estimates with 86.6% patients estimated to be having <20% 10-year risk. In comparison, RiskFRS and RiskACC/AHA returned higher risk estimates (61.7% and 69.8% with risk <20%, respectively; p values <0.001 for comparison with RiskWHO). However, the RiskJBS identified the highest proportion of the patients as being at high-risk (only 44.1% at <20% risk, p values 0 < 0.01 for comparison with all the other 3 risk scores).
  
  
  CONCLUSIONS
  This is the first study to show that in Indian patients presenting with acute MI, RiskJBS is likely to identify the largest proportion of the patients as at 'high-risk' as compared to RiskWHO, RiskFRS and RiskACC/AHA. However, large-scale prospective studies are needed to confirm these findings.
authors: Senior Consultant Cardiology, Medanta - The Medicity, Sector 38, Gurgaon 122001, Haryana, India. Electronic address: manishaiims@hotmail.com.
authors: Manish
authors: M
authors: Bansal
authors: Chairman, Clinical and Preventive Cardiology, Medanta - The Medicity, Sector 38, Gurgaon 122001, India.
authors: Ravi R
authors: RR
authors: Kasliwal
authors: Chairman, Cardiothoracic Surgery, Medanta - The Medicity, Sector 38, Gurgaon 122001, India.
authors: Naresh
authors: N
authors: Trehan
mesh_terms: D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D018570:Risk Assessment / Q000379:methods*
keywords: Atherosclerotic cardiovascular disease; Primary prevention; Risk stratification
references: J Am Coll Cardiol. 2003 May 7;41(9):1475-9
references: 12742284
references: J Clin Epidemiol. 1989;42(7):597-609
references: 2668448
references: Lancet. 2000 Jul 22;356(9226):279-84
references: 11071182
references: J Am Coll Cardiol. 2014 Jul 1;63(25 Pt A):2789-94
references: 24814487
references: Vasc Health Risk Manag. 2008;4(1):199-211
references: 18629375
references: Circulation. 2014 Jun 24;129(25 Suppl 2):S49-73
references: 24222018
references: Circulation. 2008 Feb 12;117(6):743-53
references: 18212285
references: BMJ. 2008 Jun 28;336(7659):1475-82
references: 18573856
references: BMJ. 2007 Jul 21;335(7611):136
references: 17615182
references: Circulation. 1998 May 12;97(18):1837-47
references: 9603539
references: J Assoc Physicians India. 2009 Jan;57:17-22
references: 19753753
references: Aust N Z J Public Health. 2012 Apr;36(2):141-4
references: 22487348
references: J Public Health (Oxf). 2005 Mar;27(1):93-100
references: 15749725
references: Circulation. 2002 Jan 22;105(3):310-5
references: 11804985
references: Heart. 2014 Apr;100 Suppl 2:ii1-ii67
references: 24667225
references: Neth Heart J. 2009 Apr;17(4):155-61
references: 19421361
references: Eur Heart J. 2003 Jun;24(11):987-1003
references: 12788299
references: Indian Heart J. 1996 Jul-Aug;48(4):343-53
references: 8908818
references: JAMA. 2007 Jan 17;297(3):286-94
references: 17227980
references: Lancet. 2013 Nov 30;382(9907):1762-5
references: 24268611
references: Circulation. 2014 Jun 24;129(25 Suppl 2):S1-45
references: 24222016
references: Indian Heart J. 2009 May-Jun;61(3):265-74
references: 20503833
references: Singapore Med J. 2011 Feb;52(2):116-23
references: 21373738
references: J Am Coll Cardiol. 2013 Jan 29;61(4):e78-140
references: 23256914
references: Eur Heart J. 2012 Oct;33(20):2551-67
references: 22922414
references: Heart. 2008 Jan;94(1):34-9
references: 17916661
references: J Am Coll Cardiol. 2012 Aug 14;60(7):645-81
references: 22809746