Performance of the Framingham and SCORE cardiovascular risk prediction functions in a non-diabetic population of a Spanish health care centre: a validation study

Figures & data

Table I. Baseline characteristics of the cohort studied.

	Overall population (n = 608)	Men (n = 263)	Women (n = 345)	p
Age (years)	52.8 (7.4)	50.9 (7.6)	54.2 (6.9)	< 0.001
SBP (mm Hg)	137.9 (20.1)	136.2 (19.4)	139.2 (20.5)	0.074
DBP (mm Hg)	85.1 (11.2)	85.3 (11.9)	85.0 (10.6)	0.643
Arterial hypertension, n (%)	455 (74.8%)	191 (72.6%)	264 (76.5%)	0.272
Total cholesterol (mg/dl)	245.6 (41.2)	244.2 (41.9)	246.6 (40.6)	0.377
Total cholesterol: 240–279 mg/dl, n (%)	226 (37.2%)	91 (34.6%)	135 (39.1%)	0.252
Total cholesterol > 279 mg/dl, n (%)	109 (17.9%)	48 (18.3%)	61 (17.7%)	0.856
HDL cholesterol (mg/dl)	52.1 (15.1)	45.8 (12.7)	56.8 (15.1)	< 0.001
LDL cholesterol (mg/dl)	167.9 (38.9)	168.9 (39.5)	167.2 (38.4)	0.775
Triglycerides (mg/dl)	130.7 (81.0–156.5)	155.4 (95.0–187.3)	111.8 (73.8–135.0)	< 0.001
BMI (kg/m2)	28.1 (4.3)	27.9 (3.6)	28.3 (4.7)	0.669
Smokers, n (%)	169 (27.8%)	126 (47.9%)	43 (12.5%)	< 0.001
Ex-smokers < 1 year, n (%)	25 (4.1%)	21 (8.0%)	4 (1.2%)	< 0.001
Antihypertensive therapy, n (%)	180 (29.6%)	107 (31.0%)	73 (27.8%)	0.383
Lipid-lowering therapy, n (%)	112 (18.4%)	48 (18.3%)	64 (18.6%)	0.925

Notes: Values are expressed as mean (standard deviation) or number of patients (percentage) in normal distributions, and as median (quartile 1–quartile 3) in non-normal distributions (triglycerides). SBP: systolic blood pressure. DBP: diastolic blood pressure. HDL-C: high density lipoprotein cholesterol. LDL-C: low density lipoprotein cholesterol. BMI: body mass index.

Table II. Discrimination, calibration, and validity statistics for predicted 10-year risk of cardiovascular disease by SCORE and original Framingham risk functions.

	Original Framingham function			SCORE function
	Men	Women	Total	Men	Women	Total
AUROC	0.61 (0.52–0.70)	0.66 (0.49–0.82)	0.70 (0.63–0.78)	0.81 (0.66–0.95)	0.91 (0.81–1.00)	0.86 (0.77–0.96)
Brier score*	0.1200	0.0396	0.0744	0.0221	0.0079	0.0140
Predicted/observed risks ratio	17.7%/13.3% (1.33)	9.5%/3.8% (2.50)	13.0%/7.9% (1.64)	3.0%/2.3% (1.30)	1.4%/0.9% (1.55)	2.1%/1.5% (1.40)
Sensitivity	51.4% (34.9–68.0)	15.4% (0.0–35.0)	41.7% (27.7–55.6)	83.3% (53.5–100)	33.3% (0.0–86.6)	66.7% (35.9–97.5)
Specificity	67.1% (61.0–73.2)	95.2% (87.9–100)	83.8% (80.7–86.8)	84.1% (79.6–88.5)	97.4% (95.7–99.1)	91.7% (89.5–93.9)
PLR	1.6 (1.1–2.3)	3.2 (0.8–12.5)	2.6 (1.8–3.8)	5.2 (3.3–8.2)	12.7 (2.7–77.1)	8.0 (4.7–13.6)
NLR	0.7 (0.5–1.0)	0.9 (0.7–1.1)	0.7 (0.6–0.9)	0.2 (0.0–1.2)	0.7 (0.3–1.5)	0.4 (0.1–0.9)
Utility	2.2	3.6	3.7	26.4	18.7	22.1

Notes: AUROC = Area under the receiver operating characteristic curve. PLR = positive likelihood ratio. NLR = negative likelihood ratio. *A lower score indicates better accuracy of risk estimates.

Figure 1. Risk category distribution of the population according to the original Framingham and SCORE risk functions.

Table III. Characteristics of patients identified as of high risk by any of the two functions.

	High risk by original Framingham (n = 111)	High risk by score (n = 56)
Age (years)	56.2 (6.6)	60.5 (4.1)
SBP (mm Hg)	150.3 (19.2)	158.4 (22.2)
DBP (mm Hg)	90.4 (10.3)	90.7 (11.6)
Total cholesterol (mg/dl)	256.0 (40.3)	261.4 (55.9)
HDL cholesterol (mg/dl)	40.6 (10.6)	47.1 (11.6)
LDL cholesterol (mg/dl)	186.0 (40.1)	186.1 (55.9)
Triglycerides (mg/dl)	178.2 (106.0–221.3)	156.1 (98.0–203.0)
BMI (kg/m2)	28.8 (4.1)	27.9 (3.9)
Smokers, n (%)	65 (58.6%)	39 (69.6%)
Ex-smokers < 1 year, n (%)	14 (12.6%)	1 (1.8%)
Arterial hypertension, n (%)	106 (95.5%)	52 (92.9%)
Antihypertensive therapy, n (%)	48 (43.2%)	30 (53.6%)
Lipid-lowering therapy, n (%)	29 (26.1%)	18 (32.1%)
Coronary risk by original Framingham	27.7% (6.8%)	28.3% (9.6%)
Cardiovascular risk by SCORE	5.3% (3.7%)	8.5% (3.1%)
Men, n (%)	93 (83.8%)	46 (82.1%)
Women, n (%)	18 (16.2%)	10 (17.9%)

Notes: Values are expressed as mean (standard deviation) or number of patients (percentage) in normal distributions, and as median (quartile 1–quartile 3) in non-normal distributions (triglycerides). SBP: systolic blood pressure. DBP: diastolic blood pressure. HDL-C: high density lipoprotein cholesterol. LDL-C: low density lipoprotein cholesterol. BMI: body mass index.

Table IV. Patients in the total population identified as candidates for drug therapy (lipid-lowering or antihypertensive) according to the recommendations of the SCORE guidelines, with the risk estimated by the original Framingham and SCORE functions.

		Total (n = 608)	Men (n = 263)	Women (n = 345)
Lipid-lowering therapy	Original Framingham, n (%)	189 (31.0%)	114 (43.3%)	75 (21.7%)
	SCORE, n (%)	145 (23.8%)	75 (28.5%)	70 (20.3%)
	p-value	< 0.01	< 0.001	0.833
Anti-hypertensive therapy	Original Framingham, n (%)	224 (36.8%)	110 (41.8%)	114 (33.0%)
	SCORE n (%)	190 (31.2%)	81 (30.8%)	109 (31.6%)
	p-value	0.07	< 0.01	0.919