Observational studyCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2020
Calibration and discrimination of the Framingham Risk Score and the Pooled Cohort Equations.
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In one paragraph
Observational study in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 2 of them syntheses that pooled it.
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38citing papers in PubMed, 2 pooled it
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Who cites it
38 citing papers in PubMed, 2 syntheses or guidelines pooled it, 61 citations in OpenAlex.
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- Genetic Testing for Familial Hypercholesterolemia: Health Technology Assessment.Ontario health technology assessment series · 2022Pooled it
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- Cardiovascular risk and hippocampal-cognitive coupling in Alzheimer's disease.medRxiv : the preprint server for health sciences · 2026Article
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- Performance of Traditional Cardiovascular Risk Scores and Objective Optimization in Cancer Survivors.Current oncology (Toronto, Ont.) · 2026Article
- Risk Prediction in Cardio-Oncology: Conceptual and Methodological Considerations: JACC: CardioOncology State-of-the-Art Review.JACC. CardioOncology · 2026Review
- An artificial intelligence prediction model for optimizing patient selection for cardiac imaging for the investigation of suspected coronary artery disease.European heart journal. Digital health · 2026Article
- Validation and Extension of a Risk Calculator to Predict Mood Recurrence in Young People with Bipolar Disorder.medRxiv : the preprint server for health sciences · 2026Article
- Prediction of cardiovascular disease risk in women and individuals with polycystic ovary syndrome using the American Heart Association PREVENT model: A long-term population-based cohort study.American journal of preventive cardiology · 2026Article
- Association between trabecular bone score and cardiovascular outcomes: a population-level historical cohort study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- CABIT: a novel biomarkers-integrated inflammatory risk tool for ischemic heart disease developed in the USA and prospectively validated in China.Journal of translational medicine · 2026Article
- Evaluating the potential of phenotypic age to enhance cardiovascular risk prediction over chronological age in the UK Biobank.Scientific reports · 2025Article
- Implications of five different risk models in primary prevention guidelines.European heart journal. Quality of care & clinical outcomes · 2025Observational
- Retinal Microvascular Characteristics-Novel Risk Stratification in Cardiovascular Diseases.Diagnostics (Basel, Switzerland) · 2025Article
- Harnessing Electronic Health Records and Artificial Intelligence for Enhanced Cardiovascular Risk Prediction: A Comprehensive Review.Journal of the American Heart Association · 2025Review
- Development and validation of a novel metabolic health-related nomogram to improve predictive performance of cardiovascular disease risk in patients with prediabetes.Lipids in health and disease · 2025Article
- Metabolomic and genomic prediction of common diseases in 700,217 participants in three national biobanks.Nature communications · 2024Article
- Improving Cardiovascular Disease Primary Prevention Treatment Thresholds in a New England Health Care System.JACC. Advances · 2024Article
- Validation of the European SCORE2 models in a Canadian primary care cohort.European journal of preventive cardiology · 2024Article
Corrections and comments
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Authors and funding
14 authors at 5 institutions in 1 country.
Dennis T KoSchulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta. dennis.ko@ices.on.ca.
Atul SivaswamySchulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta.
Maneesh SudSchulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta.
Gynter KotrriSchulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta.
Paymon AziziSchulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta.
Maria KohSchulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta.
Peter C AustinSchulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta.
Douglas S LeeSchulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta.
Idan RoifmanSchulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta.
George ThanassoulisSchulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta.
Karen TuSchulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta.
Jacob A UdellSchulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta.
Harindra C WijeysunderaSchulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta.
Todd J AndersonSchulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta.
Sunnybrook Health Science Centre · CAMcGill University · CAUniversity of Toronto · CAHealth Sciences Centre · CALibin Cardiovascular Institute of Alberta · CA
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAlthough accurate risk prediction is essential in guiding treatment decisions in primary prevention of atherosclerotic cardiovascular disease, the accuracy of the Framingham Risk Score (recommended by a Canadian guideline) and the Pooled Cohort Equations (recommended by US guidelines) has not been assessed in a large contemporary Canadian population. Our primary objective was to assess the calibration and discrimination of the Framingham Risk Score and Pooled Cohort Equations in Ontario, Canada.
methodsWe conducted an observational study involving Ontario residents aged 40 to 79 years, without a history of atherosclerotic cardiovascular disease, who underwent cholesterol testing and blood pressure measurement from Jan. 1, 2010, to Dec. 31, 2014. We compared predicted event rates generated by the Framingham Risk Score and the Pooled Cohort Equations with observed event rates at 5 years using linkages from validated administrative databases.
resultsOur study cohort included 84 617 individuals (mean age 56.3 yr, 56.9% female). Over a maximum follow-up period of 5 years, we observed 2162 (2.6%) events according to the outcome definition of the Framingham Risk Score, and 1224 (1.4%) events according to the outcome definition of the Pooled Cohort Equations. The predicted event rate of 5.78% by the Framingham Risk Score and 3.51% by the Pooled Cohort Equations at 5 years overestimated observed event rates by 101% and 115%, respectively. The degree of overestimation differed by age and ethnicity. The C statistics for the Framingham Risk Score (0.74) and Pooled Cohort Equations (0.73) were similar.
interpretationThe Framingham Risk Score and Pooled Cohort Equations significantly overpredicted the actual risks of atherosclerotic cardiovascular disease events in a large population from Ontario. Our finding suggests the need for further refinement of cardiovascular disease risk prediction scores to suit the characteristics of a multiethnic Canadian population.
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Risk AssessmentAdultAgedCardiovascular DiseasesCohort StudiesFemaleHumansMaleMiddle AgedOntarioReproducibility of ResultsRisk Factors
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