Background: Numerous CVD risk assessment models exist to estimate the 10-year risk of CVD for individuals; among these, the Framingham risk model is notable. Simultaneously, imaging techniques like Carotid Intima-Media Thickness (CIMT) measurement have become increasingly important as noninvasive approaches for identifying subclinical atherosclerosis. CIMT is viewed as the most straightforward assessment of CVD risk, whereas the Framingham risk model employs a variety of CVD risk factors. Therefore, it will be intriguing to explore how the Framingham risk score, an indirect predictor of CVD, correlates with a more direct assessment of CVD risk.
Objective: The study objective of the study was to determine the association of the Framingham risk model and subclinical atherosclerosis among Africans.
Methods: The present study is retrospective and cross-sectional. A total study population of 854 participants, with adults aged 40 and above, was sampled using census sampling from the AWI-Gen phase 2 project database. The following variables were extracted: age, sex, smoking status, glucose levels, family history of heart attack, Total Cholesterol levels, high-density lipoprotein cholesterol (HDL-C) levels, Systolic Blood Pressure (SBP), and Carotid Intima Media Thickness (CIMT). The Framingham risk score was calculated using Framingham risk charts. Descriptive statistics, parametric and non-parametric tests, and bivariate and multivariate regression were performed using Statistical Package for Social Sciences version 28 software to assess the relationship between the Framingham risk model and subclinical atherosclerosis.
Results: Out of 854 participants, 461 were women and 393 were men. The median Framingham risk score for the total population was 2.30 (1.20–3.30), with men having a significantly higher median than women. The proportion of Framingham risk scores (intermittent and high risk) was also significantly higher in men than in women. The mean CIMT was 0.72 ± 1.06 for the total population, with no difference between men and women. Participants with increased CIMT had significantly higher median Framingham risk scores and a higher proportion of Framingham high-risk scores than participants with normal CIMT, at 2.00 (1.203.30) and 2.80 (1.20–7.90), respectively (p = 0.044). The median Framingham risk score and proportion of high-risk scores were significantly and positively associated with CIMT, even after adjusting for known confounders such as age and gender. As the Framingham risk scores increase, chances of having increased CIMT increase by 0.948 folds with significance, and having a proportion of very high Framingham scores increases the chances of having increased CIMT by 0.220 folds with significance. The Framingham risk model Area Under the Curve (AUC) was 0.581, with a sensitivity of 32.9%, which is poor.
Conclusions: A positive relationship exists between the Framingham risk model and subclinical atherosclerosis; however, this relationship appears to be influenced by gender and age. The Framingham risk model demonstrated poor performance when validated using CIMT.
Author Contributions
Conceptualization, D.M. and S.R.C.; methodology, D.M.; software, D.M., S.R.C. and M.R.; validation, D.M., S.R.C. and M.R.; formal analysis, D.M.; writing—original draft preparation, D.M. and S.R.C.; writing—review and editing, D.M., S.R.C. and T.S.; supervision, S.R.C., M.R. and T.S. All authors have read and agreed to the published version of the manuscript.
Funding
The present study is a subproject of the AWI-Gen Genomic and environmental risk factors for cardiometabolic diseases among Africans. The National Institutes of Health (NIH) (U54HG006938) was the primary funder for the AWI-Gen project.
Institutional Review Board Statement
The permission to conduct the study was granted by the Dikgale tribal authority, and the study was approved by the Turfloop Research Ethical Committee (TREC/74/2025: PG) at the University of Limpopo.
Informed Consent Statement
Informed consent in this study was waived, as this is a secondary study, and the consent form was signed in the primary study.
Data Availability Statement
The data presented in this study are available on request from the corresponding author.
Acknowledgments
The authors would like to thank the NESP funding programme for the support given and the DIMAMO center for the provision of study data.
Conflicts of Interest
The authors declare no conflicts of interest.
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