Cardiovascular risk model performance in women with and without hypertensive disorders of pregnancy. Issue 4 (12th September 2018)

• Record Type: Journal Article
• Authors: Dam, Veerle; Onland-Moret, N Charlotte; Verschuren, W M Monique; Boer, Jolanda M A; Benschop, Laura; Franx, Arie; Moons, Karel G M; Boersma, Eric; van der Schouw, Yvonne T
• Other Names: author non-byline.; Appelman Yolande author non-byline.; Baart Sara author non-byline.; Benschop Laura author non-byline.; Boersma Eric author non-byline.; Brouwers Laura author non-byline.; J Budde Ricardo P author non-byline.; Cannegieter Suzanne C author non-byline.; Dam Veerle author non-byline.; J c eijkemans Rene M author non-byline.; J m fauser Bart C author non-byline.; Ferrari Michel D author non-byline.; Franx Arie author non-byline.; M de groot Christianne J author non-byline.; Gunning Marlise N author non-byline.; Hoek Annemiek author non-byline.; Koffijberg Hendrik author non-byline.; H koster Maria P author non-byline.; Kruit Mark C author non-byline.; Lagerweij Ghizelda R author non-byline.; Lambalk Cornelis B author non-byline.; E laven Joop S author non-byline.; Linstra Katie M author non-byline.; Der lugt Aad Van author non-byline.; E m Maas Angela H author non-byline.; Van den brink Antoinette Maassen author non-byline.; Meun Cindy author non-byline.; Middeldorp Saskia author non-byline.; M moons Karel G author non-byline.; Van rijn Bas B author non-byline.; Roeters van lennep Jeanine E author non-byline.; Roos-hesselink Jolien W author non-byline.; J scheres Luuk J author non-byline.; Van der schouw Yvonne T author non-byline.; P steegers Eric A author non-byline.; M steegers-Theunissen Regine P author non-byline.; Terwindt Gisela M author non-byline.; Velthuis Birgitta K author non-byline.; H wermer Marieke J author non-byline.; Zoet Gerbrand A author non-byline.;
• Is Part Of: Heart. Volume 105:Issue 4(2019)
• Page Start: 330
• Page End: 336
• Publication Date: 2018-09-12
• Subjects: epidemiology -- pregnancy -- coronary artery disease -- cardiac risk factors and prevention; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2018-313439
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objectives: Compare the predictive performance of Framingham Risk Score (FRS), Pooled Cohort Equations (PCEs) and Systematic COronary Risk Evaluation (SCORE) model between women with and without a history of hypertensive disorders of pregnancy (hHDP) and determine the effects of recalibration and refitting on predictive performance. Methods: We included 29 751 women, 6302 with hHDP and 17 369 without. We assessed whether models accurately predicted observed 10-year cardiovascular disease (CVD) risk (calibration) and whether they accurately distinguished between women developing CVD during follow-up and not (discrimination), separately for women with and without hHDP. We also recalibrated (updating intercept and slope) and refitted (recalculating coefficients) the models. Results: Original FRS and PCEs overpredicted 10-year CVD risks, with expected:observed (E:O) ratios ranging from 1.51 (for FRS in women with hHDP) to 2.29 (for PCEs in women without hHDP), while E:O ratios were close to 1 for SCORE. Overprediction attenuated slightly after recalibration for FRS and PCEs in both hHDP groups. Discrimination was reasonable for all models, with C-statistics ranging from 0.70-0.81 (women with hHDP) and 0.72–0.74 (women without hHDP). C-statistics improved slightly after refitting 0.71–0.83 (with hHDP) and 0.73–0.80 (without hHDP). The E:O ratio of the original PCE model was statistically significantly better in women with hHDP compared with women without hHDP. Conclusions: SCORE performed best in terms of both calibration and discrimination, while FRS and PCEs overpredicted risk in women with and without hHDP, but improved after recalibrating and refitting the models. No separate model for women with hHDP seems necessary, despite their higher baseline risk.