In many current cohorts, the Framingham Risk Score (FRS) and Pooled Cohort Equations (PCEs) overstate the risk. For a study, researchers sought to determine whether risk stratification for statin medication was enhanced by the recalibration of these scores using modern population-level data.

A cohort of Ontario individuals aged 30 to 79 years without cardiovascular disease who were alive on January 1, 2011, was used to recalibrate the five-year FRS and PCEs. In a primary care cohort comprising routinely gathered electronic medical record data from January 1, 2010, to December 31, 2014, scores were externally verified. The number of statins avoided was reported, the number needed to treat with statins to minimize a cardiovascular event at 5 years, and the relative difference in mean anticipated and observed risk.

The FRS was recalibrated in 6,938,971 Ontario residents (51.6% women, mean age 48 years) and verified in 71,450 people (56.1% women, mean age 52 years). In both women and men, recalibration decreased overestimation from 131% to 32% and 109% to 49%, respectively. According to estimates, the revised FRS will decrease the number of low-risk patients who need to be treated, dropping from 61 to 47 for women and from 53 to 41 for men, and will decrease the number of low-risk patients who receive statin prescriptions by up to 26 per 1,000 women and 80 per 1,000 men. However, the risk was still exaggerated by 128% for men and 217% for women once the PCEs were re-calibrated.

It was possible to calibrate a model to increase risk prediction. However, it depended on the model being utilized. The usage of statins may be improved by the FRS’s calibration, but not the PCEs’, which decreased overestimation.

Reference: jacc.org/doi/10.1016/j.jacc.2022.07.026