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Abstract: PO1766

Framingham Risk Score and ACC/AHA Pooled Cohort Equation for Prediction of Atherosclerotic Cardiovascular Events in CKD

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Lidgard, Benjamin, University of Washington, Seattle, Washington, United States
  • Zelnick, Leila R., University of Washington, Seattle, Washington, United States
  • Go, Alan S., Kaiser Permanente Southern California, Pasadena, California, United States
  • O'brien, Kevin D., University of Washington, Seattle, Washington, United States
  • Bansal, Nisha, University of Washington, Seattle, Washington, United States
Background

The Framingham Risk Score and the ACC/AHA Pooled Cohort Equation are used clinically to identify patients at high risk for atherosclerotic cardiovascular disease (ASCVD). The performance of these equations (alone or with clinically available cardiac biomarkers) is unclear in patients with chronic kidney disease (CKD), particularly at more advanced stages. We tested the discrimination of these risk scores and cardiac biomarkers to predict ASCVD in CKD.

Methods

We studied 1027 participants in the Chronic Renal Insufficiency Cohort without ASCVD who were not taking aspirin or statins. Framingham Risk Score, Pooled Cohort Equation, N-terminal pro-brain type natriuretic peptide (NT-proBNP), and high-sensitivity troponin T (hsTnT) were measured at baseline. Outcomes were the composite of fatal and non-fatal myocardial infarction (MI) and cardiac death, with or without stroke, over 10 years. We estimated internally valid C-indices using 10-fold cross validation for each risk score and cardiac risk marker overall, and across categories of eGFR.

Results

Among 1027 participants, the mean age was 52 years, and the mean eGFR was 48 mL/min/1.73 m2. The C-index (95% CI) was 0.74 (0.69, 0.79) for the Framingham Risk Score, and 0.72 (0.67, 0.78) for the Pooled Cohort Equation. Both risk scores had better discrimination for predicting ASCVD at eGFR >60 mL/min/1.73 m2 compared with lower eGFR. HsTnT had comparable discrimination to both risk scores overall. HsTnT alone had comparable discrimination across the spectrum of CKD severity (difference in C-index for lowest vs highest eGFR category for ASCVD -0.04; 95% CI -0.21, 0.14) (Table).

Conclusion

The Framingham Risk Score and Pooled Cohort Equation had moderate discrimination for prediction of ASCVD in CKD and performed better at eGFRs >60 versus <60 mL/min/1.73 m2. HsTnT alone had discrimination comparable to each risk score overall, and comparable discrimination across the spectrum of CKD severity. Further work is needed to develop novel risk scores including cardiac biomarkers specifically for use in CKD.

Funding

  • NIDDK Support