Nephrology · Cardiology · 5 h ago
Cardiovascular risk models underpredict risk in women with CKD
A secondary analysis of a prospective cohort evaluated five cardiovascular risk models in 21,548 postmenopausal women, including 1,095 with chronic kidney disease (CKD). Models showed limited discrimination and generally poor calibration, with most underpredicting risk among women with CKD.
- Five models showed limited discrimination in women with CKD.
- Most models underpredicted risk in women with CKD.
- PREVENT also underpredicted risk without CKD.
- Calibration was generally poor in both groups.
Researchers conducted a secondary analysis of the Women’s Health Initiative Biomarker Studies, assessing the Framingham, ATP III, ACC/AHA Pooled Cohort Equations, QRISK3, and PREVENT models in 21,548 postmenopausal women aged 50–79 without cardiovascular disease. CKD was defined as an estimated glomerular filtration rate below 60 mL/min/1.73 m². Discrimination was measured using the C-statistic, and calibration was assessed at clinically relevant decision thresholds. Outcome definitions differed across models.
Among women with CKD, C-statistics ranged from 0.57 for Framingham to 0.67 for PREVENT. In women without CKD, they ranged from 0.61 for Framingham to 0.71 for QRISK3 and PREVENT. Calibration was generally poor in both groups. Most models underpredicted risk in women with CKD; PREVENT also underpredicted risk in women without CKD.
These findings indicate that commonly used models may not accurately distinguish or estimate cardiovascular risk in postmenopausal women with CKD. The analysis does not establish a preferred alternative or show that changing clinical decisions based on these results improves outcomes. Interpretation is also limited by the cohort’s specific population and by differences in outcome definitions across models.
In practice
For postmenopausal women with CKD, these results suggest that commonly used cardiovascular risk models may provide imprecise estimates: discrimination was modest, calibration was generally poor, and most models underpredicted risk. The findings do not identify a validated replacement model or demonstrate that risk-model changes improve outcomes, so they do not by themselves support changing treatment decisions. Applicability is limited to the studied cohort of women aged 50–79 without baseline cardiovascular disease, and model outcomes differed.
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Journal of General Internal Medicine: Cardiovascular Risk Prediction in Postmenopausal Women With and Without Chronic Kidney Disease: An Observational Cohort Study ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.