Revised Framingham Stroke Risk Profile to Reflect Temporal Trends

Author:

Dufouil Carole1,Beiser Alexa1,McLure Leslie A.1,Wolf Philip A.1,Tzourio Christophe1,Howard Virginia J.1,Westwood Andrew J.1,Himali Jayandra J.1,Sullivan Lisa1,Aparicio Hugo J.1,Kelly-Hayes Margaret1,Ritchie Karen1,Kase Carlos S.1,Pikula Aleksandra1,Romero Jose R.1,D’Agostino Ralph B.1,Samieri Cécilia1,Vasan Ramachandran S.1,Chêne Genevieve1,Howard George1,Seshadri Sudha1

Affiliation:

1. From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and...

Abstract

Background: Age-adjusted stroke incidence has decreased over the past 50 years, likely as a result of changes in the prevalence and impact of various stroke risk factors. An updated version of the Framingham Stroke Risk Profile (FSRP) might better predict current risks in the FHS (Framingham Heart Study) and other cohorts. We compared the accuracy of the standard (old) and of a revised (new) version of the FSRP in predicting the risk of all-stroke and ischemic stroke and validated this new FSRP in 2 external cohorts, the 3C (3 Cities) and REGARDS (Reasons for Geographic and Racial Differences in Stroke) studies. Methods: We computed the old FSRP as originally described and a new model that used the most recent epoch-specific risk factor prevalence and hazard ratios for individuals ≥55 years of age and for the subsample ≥65 years of age (to match the age range in REGARDS and 3C studies, respectively) and compared the efficacy of these models in predicting 5- and 10-year stroke risks. Results: The new FSRP was a better predictor of current stroke risks in all 3 samples than the old FSRP (calibration χ 2 of new/old FSRP: in men: 64.0/12.1, 59.4/30.6, and 20.7/12.5; in women: 42.5/4.1, 115.4/90.3, and 9.8/6.5 in FHS, REGARDS, and 3C, respectively). In the REGARDS, the new FSRP was a better predictor among whites compared with blacks. Conclusions: A more contemporaneous, new FSRP better predicts current risks in 3 large community samples and could serve as the basis for examining geographic and racial differences in stroke risk and the incremental diagnostic utility of novel stroke risk factors.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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