ArticleLancet regional health. Americas2026
External validation and recalibration of cardiovascular risk scores for prediction of 10-year risk of fatal cardiovascular disease: a prospective, observational, population-based cohort analysis of adults in Mexico City.
Article in Lancet regional health. Americas, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
- Predictive Performance of Seven Clinical Surrogates of Visceral Adipose Tissue for Cardiovascular Mortality: A Sub-Analysis of 102 385 Adults From the Mexico City Prospective Study.Diabetes, obesity & metabolism · 2026Article
- The leukocyte glucose index: a novel inflammatory-glucose biomarker for prevalent diabetic retinopathy and its supplementary predictive capacity in individuals with type 2 diabetes mellitus.Frontiers in endocrinology · 2026Article
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Abstract
Background: Cardiovascular disease (CVD) is the leading cause of mortality in Latin America, yet most CVD risk equations were developed in high-income countries with limited validations in these settings. Here, we externally validated CVD risk prediction models for fatal CVD, and recalibrated the Globorisk-fatal model in Mexican population. Methods: We analyzed 112,262 adults ≥40 years, 67% (75,320) female and 33% (36,942) males, mean age 54.6 ± 10.7 years without prior CVD from the Mexico City Prospective Study. The primary outcome was 10-year fatal CVD, including myocardial infarction (MI) and stroke. CVD risk was estimated using the laboratory- and office-based Framingham, Globorisk, Globorisk-LAC, WHO, and SCORE2 equations. Discrimination was assessed with Harrell's c-statistic and AUROCs, calibration with mean estimates, slopes, and calibration curves, and overall performance with Brier scores. Sex-specific recalibration of the Globorisk-fatal model was performed using observed risks of fatal CVD. Findings: During 10 years of follow-up, 2429 fatal CVD events were recorded (1667 MI, 762 stroke). All models showed good discrimination, with c-statistics ranging from 0.761 to 0.805 in males and 0.797-0.831 in females. The Globorisk-fatal model had the highest c-statistic in females (0.831, 95% CI 0.821-0.841), and the laboratory-based WHO-MI model in males (0.805, 95% CI 0.783-0.827). Despite this, all equations consistently overestimated CVD risk, particularly in females. Calibration analyses revealed systematic overprediction at higher risk levels. Recalibration of the Globorisk-fatal model improved agreement between predicted and observed risks. Interpretation: CVD risk models showed good discrimination but consistently overestimated risk in this Mexican cohort. The recalibrated Globorisk-fatal model improves risk estimation of fatal CVD in Mexican adults. Funding: This research was supported by Instituto Nacional de Geriatría in Mexico.
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