Abstract 12244: Repeat Cardiovascular Risk Assessment After Four Years: Is There Improvement in Risk Prediction?
Framingham risk equations are widely used to predict cardiovascular disease based on health information from a single time point. Repeated risk assessment has been proposed, but little is known regarding use of information from repeat risk assessments and temporal change in estimated cardiovascular risk for prediction of future cardiovascular events. We aimed to compare the discrimination and risk reclassification of approaches using estimated cardiovascular risk at single and repeat risk assessments
Methods: Using data on 12,197 individuals enrolled in EPIC-Norfolk cohort, we calculated rates of cardiovascular events by levels of estimated absolute risk (Framingham risk score) at baseline and at a second health examination four years later. We calculated the area under the receiver operating characteristic curve (aROC) and risk reclassification, comparing approaches using information from single and repeat risk assessments (i.e. estimated risk at different time points).
Results: The mean Framingham risk score increased from 15.5% to 17.5% over a mean of 3.7 years from baseline to the second health examination. Individuals with high estimated risk (≥20%) at both health examinations had considerably higher rates of cardiovascular events than those who remained in the lowest risk category (≤10%) in both health examinations (34.0 (95%CI 31.7-36.6) and 2.7 (2.2-3.3) per 1000 person-years respectively). Using information from a previous risk assessment resulted in a small non-significant improvement in risk classification over the most up-to-date risk assessment (net reclassification improvement of 4.8%). Using information from both risk assessments slightly improved discrimination compared to information from a single risk assessment (aROC 0.76 and 0.75 respectively, p≤0.001).
Conclusions: Using information from repeat risk assessments over a period of four years modestly improved prediction, compared to using data from a single risk assessment.
- © 2013 by American Heart Association, Inc.