Validity of cardiovascular risk prediction models in Latin America and among Hispanics in the United States of America: A systematic review

Mery Cortes-Bergoder, Randal J. Thomas, Felipe N. Albuquerque, John A. Batsis, Gerard Burdiat, Carmen Perez-Terzic, Jorge Trejo-Gutierrez, Francisco Lopez-Jimenez

Research output: Contribution to journalReview articlepeer-review

21 Scopus citations


Objective. To assess the use and validity of prediction models to estimate the risk of cardiovascular disease (CVD) in Latin America and among Hispanic populations in the United States of America. Methods. This was a systematic review of three databases: Ovid MEDLINE (1 January 1950-15 April 2010), LILACS (1 January 1988-15 April 2010), and EMBASE (1 January 1988-15 April 2010). MeSH search terms and domains were related to CVD, prediction rules, Latin America (including the Caribbean), and Hispanics in the United States. Database searches were supplemented by correspondence with experts in the field. Results. A total of 1 655 abstracts were identified, of which five cohorts with a total of 13 142 subjects met inclusion criteria. A Mexican cohort showed that the predicted/observed event-rate ratio for coronary heart disease (CHD) according to the Framingham risk score (FRS) was 1.68 (95% CI, 1.26-2.11); incident myocardial infarction, 1.36 (95% CI, 0.90-1.83); and CHD death, 1.21 (95% CI, 0.43-2.00). In Ecuador, a prediction model for CVD and total deaths in hypertensive patients had an area under the curve (AUC) of 0.79 (95% CI, 0.72-0.86), while the World Health Organization method had an AUC of 0.74 (95% CI, 0.67-0.82). A study predicting mortality risk in people with Chagas' disease had an AUC of 0.81 (95% CI, 0.72-0.90). Among a United States cohort that included Hispanics, FRS overestimated CVD risk for Hispanics with an AUC of 0.69. Another study in the United States that assessed FRS factors predicting CVD death among Mexican-Americans had an AUC of 0.78. Conclusions. The evidence regarding CVD risk prediction rules in Latin America or among Hispanics in the United States is modest at best. It is likely that the FRS overestimates CVD risk in Hispanics when not properly recalibrated.

Original languageEnglish (US)
Pages (from-to)131-139
Number of pages9
JournalRevista Panamericana de Salud Publica/Pan American Journal of Public Health
Issue number2
StatePublished - Aug 2012


  • Cardiovascular diseases
  • Hispanic Americans
  • Latin America
  • Risk factors

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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