Several popular cardiovascular risk assessment tools have been developed in Western countries; however, the predictive abilities of these tools have not been evaluated in Middle Eastern countries. The present study aimed to determine these abilities in a population-based study in Northern Iran.

Study Design: In a Cohort study, 2883 individuals (1629 men and 1254 women), aged 40-74 years, were included. Methods: We determined the predictive abilities of American College of Cardiology/American Heart Association (ACC/AHA) risk prediction tool, Framingham general cardiovascular risk profile in primary care settings, and Systematic Coronary Risk Evaluation (SCORE) equations for low and high risk European countries. Receiver Operating Characteristic (ROC) analysis was used to determine the predictive abilities of these four risk assessment tools.

Based on Areas Under Curves (AUCs) values and related 95% confidence intervals (95% CIs), the discriminative abilities of the ACC/AHA tool, the Framingham approach, and the SCORE for low- and high-risk European countries to estimate non-fatal CVD events were 0.6625, 0.6517, 0.6476, and 0.6458, respectively, in men, and 0.7722, 0.7525, 0.7330, and 0.7331, respectively, in women. Moreover, the abilities of these four tools to estimate fatal CVD events were found to be 0.8614, 0.8329, 0.7996, and 0.7988 in men, and 0.8779, 0.8372, 0.8535, and 0.8518 in women, respectively.

The risk assessment tools investigated showed acceptable predictive abilities in women. The ACC/AHA approach however showed slightly better performance compared with SCORE tool and benfited from the lowest cost compared with all the other tools.