Comparison of Framingham Risk Scores (FRS), Joint British Society (JBS3), and American College of Cardiology/American Heart Association (ACC/AHA) Cardiovascular Risk Scores Among Adults With First Myocardial Infarction

Abstract

Introduction: The prevalence of myocardial infarction (MI) among young Indian adults is on the rise with reports suggesting 32.7% of all deaths in men and 32.6% of all deaths in women between 2010-13 were due to cardiovascular diseases (CVDs). Though various long-term cohort studies have established risk assessment scores none of them are specific to the Indian population. In this study, we look to establish which scoring system among the American College of Cardiology (ACC), Joint British Society (JBS3) and Framingham Risk Scores (FRS) would be reliable for the Indian population. A timely intervention based on the most reliable score can help mitigate cardiovascular diseases.Materials and methods: In this cross-sectional study, we included Indian adults, aged more than 40 years, with first MI. Patients previously on lipid lowering drugs were excluded. Demographic data, history, clinical information, laboratory data and other investigations were noted. Subsequently the predicted cardiovascular risk scores based on JBS3, ACC, and FRS were calculated and divided into low risk, intermediate and high risk based on the categorization of the risk scores individually.Results: There were 102 (79.1%) males and 23 (17.8%) females with a mean age of 51.01 years (standard deviation [SD]=12.82, p value <0.001). There was considerable prevalence of type 2 diabetes mellitus with 56 (47.1%) of the subjects being known diabetics.The mean 10-year risk of MI based on ACC was 12.42% (SD=10.45), mean JBS3 score was 14.45% (SD=12.67) and mean FRS score was 15.75% (SD=14.71). FRS scores when categorized, 48 (40.3%) patients had low risk, 30 (23.3%) had medium risk and 43 (33.3%) had high risk. As for ACC score, 39 (35.8%) patients were in low risk and 29 (26.6%) in intermediate risk, borderline in 18 (16.5%) and high risk in 23 (21.1%). In JBS3 scores, 53 (46.5%) patients were in low risk, 32 (28.1%) were in moderate risk and 29 (25.4%) in high risk. Conclusion:The absolute value of 10-year risk scores was highest for FRS scores. The proportion of patients whose scores were under the category of high risk was highest for FRS.

Comparison of American College of Cardiology/American Heart Association Cardiovascular Risk Score, Framingham Risk Scores, European Society of Cardiology Cardiovascular Disease Risk Calculator, QRISK3-2018 Risk Calculator in Patients Presenting with First Time with Myocardial Infarction: A Step toward the Development of Indian Cardiac Risk Score

“…[10] Our study found that the mean FRS was 12% which is in contrast with 33.3% found in Raj et al study and 20% in Garg et al study with statin eligibility. [7,9] ESCCD (SCORE) tool was not considered applicable in a study done by Hasabullah et al (22.5%), which is also comparable to our study (15.45%). [8] In another older study, Kanjilal et al compared FRS-1998, JBS, and SCORE risk calculators in unaffected Asian Indians with a family history of CAD and showed that it underestimated the risk.…”

“…[7] In contrast, the FRS-CVD score was come out as most useful in Raj et al study (the study did not include the QRISK tool). [9] If we compare individual tools, we found 11. 35% by ACC/ AHA ASCVD risk score, whereas Garg et al study got with 28.3%.…”

Recalibration of Framingham Risk Score for Predicting 10-Year Cardiovascular Disease Risk in a South Indian Population

“…8 CVD risk scores guide the clinical management of people at high risk of developing CVD events. [6][7][8] Several CVD risk prediction models have been developed during the past few decades, including the Framingham Risk Score (FRS), 9 Systematic Coronary Risk Evaluation (SCORE) 10 and SCORE2 algorithms, 11 American College of Cardiology/American Heart Association (ACC/AHA) 12 risk calculator, QRISK 13,14 and World Health Organization/International Society of Hypertension (WHO/ISH) 15 risk prediction charts, and the Revised Pooled Cohort Equations (PCE). 12 Of these, the sex-specific FRS is the most widely used risk tool globally, given its better performance than many other risk scores in various populations.…”

“…12 Of these, the sex-specific FRS is the most widely used risk tool globally, given its better performance than many other risk scores in various populations. [13][14][15] The FRS was initially developed in the late 1970s and underwent revision in 2008, using data from the original Framingham cohort, which primarily consisted of a predominantly White population in the United States. 9 For its application beyond this population, FRS requires recalibration using contemporary data on CVD risk factors and CVD rates specific to the intended populations.…”