From the Department of Biostatistics, University of Alabama at Birmingham (L.A.M., G.H.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K.); Department of Medicine, University of Vermont, Burlington (M.C.); and Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).
Stroke. 2014 Jun;45(6):1716-20. doi: 10.1161/STROKEAHA.114.004915. Epub 2014 Apr 15.
The most well-known stroke risk score is the Framingham Stroke Risk Score (FSRS), which was developed during the higher stroke risk period of the 1990s and has not been validated for blacks. We assessed the performance of the FSRS among participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study to determine whether it is useful in both blacks and whites.
Expected annualized stroke rates from the FSRS were compared with observed stroke rates overall and within strata defined by FSRS risk factors (age, sex, systolic blood pressure, use of antihypertensive medications, diabetes mellitus, smoking, atrial fibrillation, left ventricular hypertrophy, and prevalent coronary heart disease).
Among 27 748 participants stroke-free at baseline, 715 stroke events occurred over 5.6 years of follow-up. FSRS-estimated incidence rates of stroke were 1.6× higher than observed for black men, 1.9× higher for white men, 1.7× higher for black women, and 1.7× higher for white women. This overestimation was consistent among most subgroups of FSRS factors, although the magnitude of overestimation varied by the risk factor assessed.
Although higher FSRS was associated with higher stroke risk, the FSRS overestimated the observed stroke rates in this study, particularly in certain subgroups. This may be because of temporal declines in stroke rates, secular trends in prevention treatments, or differences in populations studied. More accurate estimates of event rates are critical for planning research, including clinical trials, and targeting health-care efforts.
最著名的卒中风险评分是Framingham 卒中风险评分（FSRS），该评分于 20 世纪 90 年代卒中风险较高时期开发，尚未在黑人中进行验证。我们评估了 REGARDS 研究参与者中 FSRS 的表现，以确定其在黑人和白人中是否有用。
比较 FSRS 预期的年化卒中发生率与总体观察到的卒中发生率，以及 FSRS 危险因素（年龄、性别、收缩压、使用抗高血压药物、糖尿病、吸烟、心房颤动、左心室肥厚和现患冠心病）分层内的观察到的卒中发生率。
在 27748 名基线时无卒中的参与者中，5.6 年的随访期间发生了 715 例卒中事件。FSRS 估计的卒中发生率黑人男性比观察值高 1.6 倍，白人男性高 1.9 倍，黑人女性高 1.7 倍，白人女性高 1.7 倍。尽管评估的危险因素不同，但这种高估在 FSRS 因素的大多数亚组中是一致的。
尽管 FSRS 越高与卒中风险越高相关，但在本研究中，FSRS 高估了观察到的卒中发生率，尤其是在某些亚组中。这可能是由于卒中发生率的时间下降、预防治疗的长期趋势或研究人群的差异所致。更准确的事件发生率估计对于规划研究（包括临床试验）和针对医疗保健工作至关重要。
