Stroke risk in older British men: Comparing performance of stroke-specific and composite-CVD risk prediction tools.
AF, atrial fibrillation
BRHS, British Regional Heart Study
CHD, coronary heart disease
CIF, cumulative incidence function
CPI, centred prognostic index
CVD, cardiovascular disease
Calibration
Cardiovascular disease
Discrimination
FSRP, Framingham stroke risk profile
HF, heart failure
KM, Kaplan-Meier
MI, myocardial infarction
NICE, National Institute For Health And Care Excellence
Older adults
PCE, pooled cohort equations
PI, prognostic index
Risk prediction
SCORE, systematic coronary risk evaluation
Sn/Sp, percent sensitivity/percent specificity
Stroke
TIA, transient ischemic attack
Journal
Preventive medicine reports
ISSN: 2211-3355
Titre abrégé: Prev Med Rep
Pays: United States
ID NLM: 101643766
Informations de publication
Date de publication:
Feb 2023
Feb 2023
Historique:
received:
23
09
2022
revised:
14
12
2022
accepted:
22
12
2022
entrez:
23
2
2023
pubmed:
24
2
2023
medline:
24
2
2023
Statut:
epublish
Résumé
Stroke risk is currently estimated as part of the composite risk of cardiovascular disease (CVD). We investigated if composite-CVD risk prediction tools QRISK3 and Pooled Cohort Equations-PCE, derived from middle-aged adults, are as good as stroke-specific Framingham Stroke Risk Profile-FSRP and QStroke for capturing the true risk of stroke in older adults. External validation for 10y stroke outcomes was performed in men (60-79y) of the British Regional Heart Study. Discrimination and calibration were assessed in separate validation samples (FSRP n = 3762, QStroke n = 3376, QRISK3 n = 2669 and PCE n = 3047) with/without adjustment for competing risks. Sensitivity/specificity were examined using observed and clinically recommended thresholds. Performance of FSRP, QStroke and QRISK3 was further compared head-to-head in 2441 men free of a range of CVD, including across age-groups. Observed 10y risk (/1000PY) ranged from 6.8 (hard strokes) to 11 (strokes/transient ischemic attacks). All tools discriminated weakly, C-indices 0.63-0.66. FSRP and QStroke overestimated risk at higher predicted probabilities. QRISK3 and PCE showed reasonable calibration overall with minor mis-estimations across the risk range. Performance worsened on adjusting for competing non-stroke deaths. However, in men without CVD, QRISK3 displayed relatively better calibration for stroke events, even after adjustment for competing deaths, including in oldest men. All tools displayed similar sensitivity (63-73 %) and specificity (52-54 %) using observed risks as cut-offs. When QRISK3 and PCE were evaluated using thresholds for CVD prevention, sensitivity for stroke events was 99 %, with false positive rate 97 % suggesting existing intervention thresholds may need to be re-examined to reflect age-related stroke burden.
Identifiants
pubmed: 36820364
doi: 10.1016/j.pmedr.2022.102098
pii: S2211-3355(22)00405-3
pmc: PMC9938339
doi:
Types de publication
Journal Article
Langues
eng
Pagination
102098Informations de copyright
© 2022 The Author(s).
Déclaration de conflit d'intérêts
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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