Revised Framingham Stroke Risk Profile to Reflect Temporal Trends

Abstract

Background Age-adjusted stroke incidence has decreased over the past 50 years, likely due to 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 Framingham Heart Study (FHS) 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 two external cohorts, the 3 Cities (3C) and REGARDS studies. Methods We computed the old FSRP as originally described, and a new model that used the most recent epoch-specific risk factors' prevalence and hazard-ratios for persons ≥ 55 years and for the subsample ≥ 65 years (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 three samples than the old FSRP (Calibration chi-squares 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 to 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.

Plasma total‐tau as a biomarker of stroke risk in the community

“…8 We examined whether plasma t-tau could improve risk stratification for incident stroke over and the above the FSRP by calculating the continuous net reclassification improvement (NRI) applicable to survival data, taking into account events, nonevents, and censoring. Follow-up was from the baseline exam to the time of incident event, death, or date the participant was last known to be stroke free, through to 2016.…”

“…The FSRP was validated in 3 large community cohorts. 8 We examined whether plasma t-tau could improve risk stratification for incident stroke over and the above the FSRP by calculating the continuous net reclassification improvement (NRI) applicable to survival data, taking into account events, nonevents, and censoring. 9,10 The 95% confidence interval (CI) was calculated using bootstrap methods.…”

Self-Reported Stroke Risk Stratification

“…The FSRF was calculated as described in a recently reported paper, 2 and with factors including: Demographic factors: age and sex (note that black race is not included in the FSRF);Stroke risk factors; Systolic blood pressure, calculated as the average of two measurements taken a minute apart after the participant had rested for 5 minutes;Self-reported use of antihypertensive medications;Diabetes, defined as a fasting glucose of ≥126 mg/dL (or ≥200 mg/dL for those failing to fast), or self-reported use of medications for glucose control;Current cigarette smoking, assessed by a positive response to both questions “Have you ever smoked at least 100 cigarettes in your lifetime?” and “Do you smoke cigarettes now, even occasionally?”;Atrial fibrillation, defined by self-report (as below for the SRSRF) plus ECG evidence;History of heart disease, defined by self-reported myocardial infarction (as below for the SRSRF) or self-reported revascularization (coronary artery bypass graft, angioplasty or stenting), or ECG evidence of a previous myocardial infarction.…”

“…The long-standing standard for stroke risk stratification in the US is the Framingham Stroke Risk Function (FSRF), 1 which has recently been updated to reflect current risk factor levels and temporal changes in the association between risk factors and stroke risk. 2 However, the FSRF requires a blood draw to establish diabetes, a blood pressure measurement to obtain systolic blood pressure levels, and an ECG to establish atrial fibrillation.…”

A novel risk calculator to predict outcome after surgery for symptomatic spinal metastases; use of a large prospective patient database to personalise surgical management

“…With the advent of immunomodulatory drug therapies, previous prognostic scoring systems will not accurately predict survival for renal cell carcinoma metastases, 28 whereas risk calculators can be updated to maintain usefulness, in a similar fashion to the Framingham stroke risk calculator. 15,29 It is important to understand the limitations of the risk calculator, which should not be generalized to non-surgical cancer patients, and due to standard error may be inaccurate for Snapshot of the online risk calculator…”