Waimei Tai, MD
McClure et al did an interesting study where they took the Framingham Stroke Risk Calculator (FSRC) and calculated the risk scores of their cohort of patients in the REGARDS trial. They then compared the estimated stroke events to the observed stroke events to see if the FSRC was a good predictor of actual stroke events. They learned that the FSRC was good at stratifying who was at higher risk, but tended to overestimate the number of events this group would have. This was consistent across different strata in the REGARDS groups.
They authors do comment on a few reasons why this maybe the case including: overall temporal decline in stroke incidence as the decades have passed and better preventative measures have taken place to control for risk factors; use of adjudicated events versus self-reported events as in the initial validation studies. The authors suggest that the biggest contributors to the FSRC being an overestimator of risk is the overall decline of stroke incidence over the decades.
This means that some of our prevention measures are working, patients and their healthcare providers are working to reduce the incidence of stroke with medication, lifestyle modifications, re-vascularization in some cases. But more work still needs to be done.
I think this study is more relevant as it contributes to the larger conversation about the recent AHA/ACC guidelines on lipid management . As a believer that an ounce of prevention is worth a pound of cure, I am still a proponent of aggressive lipid management, even if the current epidemiologic studies suggest that stroke incidence is declining. Perhaps it is because of the very preventative work we are actively engaging in.