ArticleOpen heart2024
Performance of contemporary cardiovascular risk stratification scores in Brazil: an evaluation in the ELSA-Brasil study.
Article in Open heart, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Validation of the European SCORE2 algorithm in one European and one Latin-American cohort studies with contrasting populations.European heart journal. Quality of care & clinical outcomes · 2026Observational
- Artificial Intelligence-enhanced Electrocardiography for Heart Failure Screening and Risk Stratification.Current heart failure reports · 2026Review
- Distributed Precision Stroke Care: Artificial Intelligence-Driven Stroke Management Using Multimodal Sensor Data.Stroke · 2026Review
- Cardiovascular risk stratification without recalibration: A comparative study of the PREVENT and WHO risk scores in a multiethnic Brazilian cohort.American journal of preventive cardiology · 2026Article
- Calcium Score, Non-Obstructive Coronary Artery Disease and Cardiovascular Events.Arquivos brasileiros de cardiologia · 2026Article
- Artificial Intelligence-Enabled Prediction of Heart Failure Risk From Single-Lead Electrocardiograms.JAMA cardiology · 2025Article
- Heart failure risk stratification using artificial intelligence applied to electrocardiogram images: a multinational study.European heart journal · 2025Article
- Prediction of cardiovascular risk: validation of a non-laboratory and a laboratory-based score in a Brazilian community-based cohort of the PURE study.Lancet regional health. Americas · 2025Article
- Agreement between Framingham, Pooled Cohort Equations, and Globorisk-LAC in the Estimation of Cardiovascular Risk in Brazil, 2013.Arquivos brasileiros de cardiologia · 2025Article
- Leveraging AI-enhanced digital health with consumer devices for scalable cardiovascular screening, prediction, and monitoring.NPJ cardiovascular health · 2025Review
- Artificial Intelligence Enabled Prediction of Heart Failure Risk from Single-lead Electrocardiograms.medRxiv : the preprint server for health sciences · 2024Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
aimsDespite notable population differences in high-income and low- and middle-income countries (LMICs), national guidelines in LMICs often recommend using US-based cardiovascular disease (CVD) risk scores for treatment decisions. We examined the performance of widely used international CVD risk scores within the largest Brazilian community-based cohort study (Brazilian Longitudinal Study of Adult Health, ELSA-Brasil).
methodsAll adults 40-75 years from ELSA-Brasil (2008-2013) without prior CVD who were followed for incident, adjudicated CVD events (fatal and non-fatal MI, stroke, or coronary heart disease death). We evaluated 5 scores-Framingham General Risk (FGR), Pooled Cohort Equations (PCEs), WHO CVD score, Globorisk-LAC and the Systematic Coronary Risk Evaluation 2 score (SCORE-2). We assessed their discrimination using the area under the receiver operating characteristic curve (AUC) and calibration with predicted-to-observed risk (P/O) ratios-overall and by sex/race groups.
resultsThere were 12 155 individuals (53.0±8.2 years, 55.3% female) who suffered 149 incident CVD events. All scores had a model AUC>0.7 overall and for most age/sex groups, except for white women, where AUC was <0.6 for all scores, with higher overestimation in this subgroup. All risk scores overestimated CVD risk with 32%-170% overestimation across scores. PCE and FGR had the highest overestimation (P/O ratio: 2.74 (95% CI 2.42 to 3.06)) and 2.61 (95% CI 1.79 to 3.43)) and the recalibrated WHO score had the best calibration (P/O ratio: 1.32 (95% CI 1.12 to 1.48)).
conclusionIn a large prospective cohort from Brazil, we found that widely accepted CVD risk scores overestimate risk by over twofold, and have poor risk discrimination particularly among Brazilian women. Our work highlights the value of risk stratification strategies tailored to the unique populations and risks of LMICs.
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