Performance of cardiovascular risk prediction equations in Indigenous Australians

Elizabeth Laurel Mary Barr, Federica Barzi, Athira Rohit, Joan Cunningham, Shaun Tatipata, Robyn McDermott, Wendy E Hoy, Zhiqiang Wang, Pamela June Bradshaw, Lyn Dimer, Peter L Thompson, Julie Brimblecombe, Kerin O'Dea, Christine Connors, Paul Burgess, Steven Guthridge, Alex Brown, Alan Cass, Jonathan E Shaw, Louise Maple-Brown

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To assess the performance of cardiovascular disease (CVD) risk equations in Indigenous Australians.

METHODS: We conducted an individual participant meta-analysis using longitudinal data of 3618 Indigenous Australians (55% women) aged 30-74 years without CVD from population-based cohorts of the Cardiovascular Risk in IndigenouS People(CRISP) consortium. Predicted risk was calculated using: 1991 and 2008 Framingham Heart Study (FHS), the Pooled Cohorts (PC), GloboRisk and the Central Australian Rural Practitioners Association (CARPA) modification of the FHS equation. Calibration, discrimination and diagnostic accuracy were evaluated. Risks were calculated with and without the use of clinical criteria to identify high-risk individuals.

RESULTS: When applied without clinical criteria, all equations, except the CARPA-adjusted FHS, underestimated CVD risk (range of percentage difference between observed and predicted CVD risks: -55% to -14%), with underestimation greater in women (-63% to -13%) than men (-47% to -18%) and in younger age groups. Discrimination ranged from 0.66 to 0.72. The CARPA-adjusted FHS equation showed good calibration but overestimated risk in younger people, those without diabetes and those not at high clinical risk. When clinical criteria were used with risk equations, the CARPA-adjusted FHS algorithm scored 64% of those who had CVD events as high risk; corresponding figures for the 1991-FHS were 58% and were 87% for the PC equation for non-Hispanic whites. However, specificity fell.

CONCLUSION: The CARPA-adjusted FHS CVD risk equation and clinical criteria performed the best, achieving higher combined sensitivity and specificity than other equations. However, future research should investigate whether modifications to this algorithm combination might lead to improved risk prediction.

LanguageEnglish
JournalHeart
DOIs
Publication statusE-pub ahead of print - 16 Jan 2020

Keywords

  • cardiovascular
  • Indigenous
  • Australians
  • cardiovascular disease
  • CVD

Cite this

Barr, E. L. M., Barzi, F., Rohit, A., Cunningham, J., Tatipata, S., McDermott, R., ... Maple-Brown, L. (2020). Performance of cardiovascular risk prediction equations in Indigenous Australians. Heart. https://doi.org/10.1136/heartjnl-2019-315889
Barr, Elizabeth Laurel Mary ; Barzi, Federica ; Rohit, Athira ; Cunningham, Joan ; Tatipata, Shaun ; McDermott, Robyn ; Hoy, Wendy E ; Wang, Zhiqiang ; Bradshaw, Pamela June ; Dimer, Lyn ; Thompson, Peter L ; Brimblecombe, Julie ; O'Dea, Kerin ; Connors, Christine ; Burgess, Paul ; Guthridge, Steven ; Brown, Alex ; Cass, Alan ; Shaw, Jonathan E ; Maple-Brown, Louise. / Performance of cardiovascular risk prediction equations in Indigenous Australians. In: Heart. 2020.
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title = "Performance of cardiovascular risk prediction equations in Indigenous Australians",
abstract = "OBJECTIVE: To assess the performance of cardiovascular disease (CVD) risk equations in Indigenous Australians.METHODS: We conducted an individual participant meta-analysis using longitudinal data of 3618 Indigenous Australians (55{\%} women) aged 30-74 years without CVD from population-based cohorts of the Cardiovascular Risk in IndigenouS People(CRISP) consortium. Predicted risk was calculated using: 1991 and 2008 Framingham Heart Study (FHS), the Pooled Cohorts (PC), GloboRisk and the Central Australian Rural Practitioners Association (CARPA) modification of the FHS equation. Calibration, discrimination and diagnostic accuracy were evaluated. Risks were calculated with and without the use of clinical criteria to identify high-risk individuals.RESULTS: When applied without clinical criteria, all equations, except the CARPA-adjusted FHS, underestimated CVD risk (range of percentage difference between observed and predicted CVD risks: -55{\%} to -14{\%}), with underestimation greater in women (-63{\%} to -13{\%}) than men (-47{\%} to -18{\%}) and in younger age groups. Discrimination ranged from 0.66 to 0.72. The CARPA-adjusted FHS equation showed good calibration but overestimated risk in younger people, those without diabetes and those not at high clinical risk. When clinical criteria were used with risk equations, the CARPA-adjusted FHS algorithm scored 64{\%} of those who had CVD events as high risk; corresponding figures for the 1991-FHS were 58{\%} and were 87{\%} for the PC equation for non-Hispanic whites. However, specificity fell.CONCLUSION: The CARPA-adjusted FHS CVD risk equation and clinical criteria performed the best, achieving higher combined sensitivity and specificity than other equations. However, future research should investigate whether modifications to this algorithm combination might lead to improved risk prediction.",
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author = "Barr, {Elizabeth Laurel Mary} and Federica Barzi and Athira Rohit and Joan Cunningham and Shaun Tatipata and Robyn McDermott and Hoy, {Wendy E} and Zhiqiang Wang and Bradshaw, {Pamela June} and Lyn Dimer and Thompson, {Peter L} and Julie Brimblecombe and Kerin O'Dea and Christine Connors and Paul Burgess and Steven Guthridge and Alex Brown and Alan Cass and Shaw, {Jonathan E} and Louise Maple-Brown",
note = "{\circledC} Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.",
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Barr, ELM, Barzi, F, Rohit, A, Cunningham, J, Tatipata, S, McDermott, R, Hoy, WE, Wang, Z, Bradshaw, PJ, Dimer, L, Thompson, PL, Brimblecombe, J, O'Dea, K, Connors, C, Burgess, P, Guthridge, S, Brown, A, Cass, A, Shaw, JE & Maple-Brown, L 2020, 'Performance of cardiovascular risk prediction equations in Indigenous Australians', Heart. https://doi.org/10.1136/heartjnl-2019-315889

Performance of cardiovascular risk prediction equations in Indigenous Australians. / Barr, Elizabeth Laurel Mary; Barzi, Federica; Rohit, Athira; Cunningham, Joan; Tatipata, Shaun; McDermott, Robyn; Hoy, Wendy E; Wang, Zhiqiang; Bradshaw, Pamela June; Dimer, Lyn; Thompson, Peter L; Brimblecombe, Julie; O'Dea, Kerin; Connors, Christine; Burgess, Paul; Guthridge, Steven; Brown, Alex; Cass, Alan; Shaw, Jonathan E; Maple-Brown, Louise.

In: Heart, 16.01.2020.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Performance of cardiovascular risk prediction equations in Indigenous Australians

AU - Barr, Elizabeth Laurel Mary

AU - Barzi, Federica

AU - Rohit, Athira

AU - Cunningham, Joan

AU - Tatipata, Shaun

AU - McDermott, Robyn

AU - Hoy, Wendy E

AU - Wang, Zhiqiang

AU - Bradshaw, Pamela June

AU - Dimer, Lyn

AU - Thompson, Peter L

AU - Brimblecombe, Julie

AU - O'Dea, Kerin

AU - Connors, Christine

AU - Burgess, Paul

AU - Guthridge, Steven

AU - Brown, Alex

AU - Cass, Alan

AU - Shaw, Jonathan E

AU - Maple-Brown, Louise

N1 - © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2020/1/16

Y1 - 2020/1/16

N2 - OBJECTIVE: To assess the performance of cardiovascular disease (CVD) risk equations in Indigenous Australians.METHODS: We conducted an individual participant meta-analysis using longitudinal data of 3618 Indigenous Australians (55% women) aged 30-74 years without CVD from population-based cohorts of the Cardiovascular Risk in IndigenouS People(CRISP) consortium. Predicted risk was calculated using: 1991 and 2008 Framingham Heart Study (FHS), the Pooled Cohorts (PC), GloboRisk and the Central Australian Rural Practitioners Association (CARPA) modification of the FHS equation. Calibration, discrimination and diagnostic accuracy were evaluated. Risks were calculated with and without the use of clinical criteria to identify high-risk individuals.RESULTS: When applied without clinical criteria, all equations, except the CARPA-adjusted FHS, underestimated CVD risk (range of percentage difference between observed and predicted CVD risks: -55% to -14%), with underestimation greater in women (-63% to -13%) than men (-47% to -18%) and in younger age groups. Discrimination ranged from 0.66 to 0.72. The CARPA-adjusted FHS equation showed good calibration but overestimated risk in younger people, those without diabetes and those not at high clinical risk. When clinical criteria were used with risk equations, the CARPA-adjusted FHS algorithm scored 64% of those who had CVD events as high risk; corresponding figures for the 1991-FHS were 58% and were 87% for the PC equation for non-Hispanic whites. However, specificity fell.CONCLUSION: The CARPA-adjusted FHS CVD risk equation and clinical criteria performed the best, achieving higher combined sensitivity and specificity than other equations. However, future research should investigate whether modifications to this algorithm combination might lead to improved risk prediction.

AB - OBJECTIVE: To assess the performance of cardiovascular disease (CVD) risk equations in Indigenous Australians.METHODS: We conducted an individual participant meta-analysis using longitudinal data of 3618 Indigenous Australians (55% women) aged 30-74 years without CVD from population-based cohorts of the Cardiovascular Risk in IndigenouS People(CRISP) consortium. Predicted risk was calculated using: 1991 and 2008 Framingham Heart Study (FHS), the Pooled Cohorts (PC), GloboRisk and the Central Australian Rural Practitioners Association (CARPA) modification of the FHS equation. Calibration, discrimination and diagnostic accuracy were evaluated. Risks were calculated with and without the use of clinical criteria to identify high-risk individuals.RESULTS: When applied without clinical criteria, all equations, except the CARPA-adjusted FHS, underestimated CVD risk (range of percentage difference between observed and predicted CVD risks: -55% to -14%), with underestimation greater in women (-63% to -13%) than men (-47% to -18%) and in younger age groups. Discrimination ranged from 0.66 to 0.72. The CARPA-adjusted FHS equation showed good calibration but overestimated risk in younger people, those without diabetes and those not at high clinical risk. When clinical criteria were used with risk equations, the CARPA-adjusted FHS algorithm scored 64% of those who had CVD events as high risk; corresponding figures for the 1991-FHS were 58% and were 87% for the PC equation for non-Hispanic whites. However, specificity fell.CONCLUSION: The CARPA-adjusted FHS CVD risk equation and clinical criteria performed the best, achieving higher combined sensitivity and specificity than other equations. However, future research should investigate whether modifications to this algorithm combination might lead to improved risk prediction.

KW - cardiovascular

KW - Indigenous

KW - Australians

KW - cardiovascular disease

KW - CVD

U2 - 10.1136/heartjnl-2019-315889

DO - 10.1136/heartjnl-2019-315889

M3 - Article

JO - Heart

T2 - Heart

JF - Heart

SN - 1355-6037

ER -

Barr ELM, Barzi F, Rohit A, Cunningham J, Tatipata S, McDermott R et al. Performance of cardiovascular risk prediction equations in Indigenous Australians. Heart. 2020 Jan 16. https://doi.org/10.1136/heartjnl-2019-315889