Recalibration of the framingham equation for predicting cardiovascular risk in latin america

Cardiovascular diseases (CVD) account for 30% of all deaths worldwide. Cardiovascular prevention in Latin America (LA) is based on the use of the Framingham equation as a tool to predict cardiovascular risk. A calibrated version of the Framingham equation for use in Latin America is not available, even though it is needed for cost-effective cardiovascular prevention. The objective of this study was to recalibrate the Framingham equation for use in the LA population. We used cross-sectional data from 22,468 free-living individuals 30 to 74 years old from the Latin American Studies on Obesity (LASO) to estimate the distribution of CVD risk factors. We estimated the baseline incidence of CVD in LA using two approaches. First, we used CVD prevalence data from LASO to back estimate the incidence of CVD using the DisMod II model. Second, we conducted a meta-analysis of published data on the incidence of CVD in LA countries to get a pooled estimate of the incidence of CVD using a random-effects model. Then, we recalibrated the Framingham equation by plugging into the formula the above mentioned estimates while keeping the original regression coefficients. The Framingham equation was accurate in predicting 10-year risk of CVD in women and overestimated the risk by 41% in men. The degree of overestimation in men decreased as age increased, as well as in patients with hypertension, hypercholesterolemia, obesity, or diabetes. Findings from this study suggest that the original Framingham equation is accurate to identify women but not men at high risk of CVD in LA.