Statistical evaluation of adding multiple risk factors improves Framingham stroke risk score

Background: Framingham Stroke Risk Score (FSRS) is the most well-regarded risk appraisal tools for evaluating an individual's absolute risk on stroke onset. However, several widely accepted risk factors for stroke were not included in the original Framingham model. This study proposed a new model which combines an existing risk models with new risk factors using synthesis analysis, and applied it to the longitudinal Atherosclerosis Risk in Communities (ARIC) data set. Methods: Risk factors in original prediction models and new risk factors in proposed model had been discussed. Three measures, like discrimination, calibration and reclassification, were used to evaluate the performance of the original Framingham model and new risk prediction model. Results: Modified C-statistics, Hosmer-Lemeshow Test and classless NRI, class NRI were the statistical indices which, respectively, denoted the performance of discrimination, calibration and reclassification for evaluating the newly developed risk prediction model on stroke onset. It showed that the NEW-STROKE (new stroke risk score prediction model) model had higher modified C-statistics, smaller Hosmer-Lemeshow chi-square values after recalibration than original FSRS model, and the classless NRI and class NRI of the NEW-STROKE model over the original FSRS model were all significantly positive in overall group. Conclusion: The NEW- STROKE integrated with seven literature-derived risk factors outperformed the original FSRS model in predicting the risk score of stroke. It illustrated that seven literature-derived risk factors contributed significantly to stroke risk prediction.