Association of Framingham cardiovascular disease risk scores with 10-year risk of CVD mortality

Abstract Background Few cohort studies examine the association of cardiovascular risk scores with cardiovascular mortality in India. This study assessed the Framingham risk score's association and predictive validity with 10-year CVD mortality risk in rural Tamil Nadu, India. Methods A retrospective cohort study in 2022 assessed the risk factors for 10-year CVD mortality in rural South India. Causes of death for adults aged 30-64 years from a 2011-12 STEPS survey were obtained through vital event surveillance. Baseline FRS CVD scores were calculated using original and published recalibration equations. Results Of 3418 participants (1480 males, 1938 females), free of CVD at baseline, were followed up for mortality for 10.22 years (median). The CVD mortality rate was 3.01 per 1,000 person-years among males and 1.36 in females. Those with baseline original lipid-based FRS ≥ 20% had higher CVD mortality risk (Hazard ratio males: 11.18, 95%CI:4.67-26.79; females: 17.51, 95%CI: 6.07-50.55) compared to scores < 10%, with similar results using recalibrated scores. Discrimination statistics (Harrell's C) were 0.755 and 0.751 for original and recalibrated lipid-based scores in males, compared to 0.734 and 0.842 in females. Conclusions FRS had good predictive validity for cardiovascular mortality in a rural Indian population, confirming its usefulness clinically. Key messages • The Framingham Risk Score is a good predictor of the 10-year risk of CVD mortality for rural South India. • Both original FRS scores and recalibrated FRS scores were similar in their predictive validity, implying that the original scores can be used for clinical practice.