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Circulation. 2017 Feb 3. pii: CIRCULATIONAHA.115.021275. doi: 10.1161/CIRCULATIONAHA.115.021275. [Epub ahead of print]

A Revised Framingham Stroke Risk Profile to Reflect Temporal Trends.

Author information

  • 1INSERM Center 897, Bordeaux University, Bordeaux, France & CIC-1401 Clinical Epidemiology Branch and The Department of Public Health, Bordeaux CHU, Bordeaux, France.
  • 2The Department of Neurology, School of Medicine, Boston University, Boston, MA; The Department of Biostatistics, School of Public Health, Boston University, Boston, MA; NHLBI's Framingham Heart Study, Framingham, MA.
  • 3Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA.
  • 4The Department of Neurology, School of Medicine, Boston University, Boston, MA & NHLBI's Framingham Heart Study, Framingham, MA.
  • 5INSERM Center 897, Bordeaux University, Bordeaux, France.
  • 6Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.
  • 7NHLBI's Framingham Heart Study, Framingham, MA.
  • 8The Department of Biostatistics, School of Public Health, Boston University, Boston, MA.
  • 9INSERM Unit 1061, Montpellier University, Montpellier, France.
  • 10NHLBI's Framingham Heart Study, Framingham, MA & The Department of Mathematics, Boston University, Boston, MA.
  • 11Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.
  • 12The Department of Neurology, School of Medicine, Boston University, Boston, MA & NHLBI's Framingham Heart Study, Framingham, MA suseshad@bu.edu.

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.

KEYWORDS:

cerebrovascular disease/stroke; cohort study; epidemiology; prediction statistics; primary prevention

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