Objectives To evaluate a Framingham 5-year cardiovascular disease (CVD) risk score in Indians and Europeans in New Zealand, and determine whether body mass index (BMI) and socioeconomic deprivation were independent predictors of CVD risk.
Methods We included Indians and Europeans, aged 30–74 years without prior CVD undergoing risk assessment in New Zealand primary care during 2002–2015 (n=256 446). Risk profiles included standard Framingham predictors (age, sex, systolic blood pressure, total cholesterol/high-density lipoprotein ratio, smoking and diabetes) and were linked with national CVD hospitalisations and mortality datasets. Discrimination was measured by the area under the receiver operating characteristics curve (AUC) and calibration examined graphically. We used Cox regression to study the impact of BMI and deprivation on the risk of CVD with and without adjustment for the Framingham score.
Results During follow-up, 8105 and 1156 CVD events occurred in Europeans and Indians, respectively. Higher AUCs of 0.76 were found in Indian men (95% CI 0.74 to 0.78) and women (95% CI 0.73 to 0.78) compared with 0.74 (95% CI 0.73 to 0.74) in European men and 0.72 (95% CI 0.71 to 0.73) in European women. Framingham was best calibrated in Indian men, and overestimated risk in Indian women and in Europeans. BMI and deprivation were positively associated with CVD, also after adjustment for the Framingham risk score, although the BMI association was attenuated.
Conclusions The Framingham risk model performed reasonably well in Indian men, but overestimated risk in Indian women and in Europeans. BMI and socioeconomic deprivation could be useful predictors in addition to a Framingham score.
- coronary artery disease
- risk stratification
- risk factors
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Contributors RTJ and HEM contributed to the conception and design of the work. RTJ was responsible for the collection of data. RP and SM contributed with definition of end points and preparation of the dataset. RMS provided ideas for analyses and contributed to the analysis of data. KSR drafted the paper and carried out the data analyses. All authors contributed to the interpretation of results as well as critical reading and revision of the draft. All authors approved the final manuscript for submission.
Funding This work was supported by the Norwegian Extra-Foundation for Health and Rehabilitation (grant number 2012-2-0129).
Competing interests RTJ and SM report grants from Health Research Council of New Zealand.
Patient consent Not required.
Ethics approval The PREDICT study was approved by the Northern Region Ethics Committee Y in 2003 (AKY/03/12/134), and later annually approved by the National Multiregion Ethics Committee since 2007 (MEC07/19/EXP).
Provenance and peer review Not commissioned; externally peer reviewed.