@article {Al-Shamsie040680, author = {Saif Al-Shamsi and Romona Devi Govender and Jeffrey King}, title = {External validation and clinical usefulness of three commonly used cardiovascular risk prediction scores in an Emirati population: a retrospective longitudinal cohort study}, volume = {10}, number = {10}, elocation-id = {e040680}, year = {2020}, doi = {10.1136/bmjopen-2020-040680}, publisher = {British Medical Journal Publishing Group}, abstract = {Objectives Cardiovascular disease (CVD) risk prediction models are useful tools for identifying those at high risk of cardiovascular events in a population. No studies have evaluated the performance of such risk models in an Arab population. Therefore, in this study, the accuracy and clinical usefulness of two commonly used Framingham-based risk models and the 2013 Pooled Cohort Risk Equation (PCE) were assessed in a United Arab Emirates (UAE) national population.Design A 10-year retrospective cohort study.Setting Outpatient clinics at a tertiary care hospital, Al-Ain, UAE.Participants The study cohort included 1041 UAE nationals aged 30{\textendash}79 who had no history of CVD at baseline. Patients were followed until 31 December 2019. Eligible patients were grouped into the PCE and the Framingham validation cohorts.Exposure The 10-year predicted risk for CVD for each patient was calculated using the 2008 Framingham risk model, the 2008 office-based Framingham risk model, and the 2013 PCE model.Primary outcome measure The discrimination, calibration and clinical usefulness of the three models for predicting 10-year cardiovascular risk were assessed.Results In women, the 2013 PCE model showed marginally better discrimination (C-statistic: 0.77) than the 2008 Framingham models (C-statistic: 0.74{\textendash}0.75), whereas all three models showed moderate discrimination in men (C-statistic: 0.69-0.70). All three models overestimated CVD risk in both men and women, with higher levels of predicted risk. The 2008 Framingham risk model (high-risk threshold of 20\%) classified only 46\% of women who subsequently developed incident CVD within 10 years as high risk. The 2013 PCE risk model (high-risk threshold of 7.5\%) classified 74\% of men who did not develop a cardiovascular event as high risk.Conclusions None of the three models is accurate for predicting cardiovascular risk in UAE nationals. The performance of the models could potentially be improved by recalibration.}, issn = {2044-6055}, URL = {https://bmjopen.bmj.com/content/10/10/e040680}, eprint = {https://bmjopen.bmj.com/content/10/10/e040680.full.pdf}, journal = {BMJ Open} }