{"doi":"10.1101/2025.09.07.25335293","title":"External validation and recalibration of office- and laboratory-based cardiovascular risk scores for prediction of 10-year risk of fatal cardiovascular disease in 112,262 adults in Mexico City","abstract":"BACKGROUND: Cardiovascular disease (CVD) is the leading cause of mortality in Latin America, yet most CVD risk prediction models were developed in high-income countries with limited validations in these settings. OBJECTIVES: To externally validate CVD risk prediction models for 10-year fatal CVD, and recalibrate the Globorisk-fatal model in Mexican population. METHODS: We analyzed 112,262 adults ≥40 years from the Mexico City Prospective Study. Outcomes were restricted to fatal CVD, including myocardial infarction (MI) and stroke, censored at 10 years. CVD risk was estimated using the laboratory- and office-based Framingham, Globorisk, Globorisk-LAC, WHO, and SCORE2 equations. Discrimination was assessed with Harrell's c-statistic and AUROCs, calibration with mean estimates, slopes, and calibration curves, and overall performance with Brier scores. Sex-specific recalibration of the Globorisk-fatal model was performed using observed 10-year risks. RESULTS: During 10 years of follow-up, 2,429 fatal CVD events were recorded (1,667 MI, 762 stroke). All models showed good discrimination, with c-statistics ranging from 0.761-0.805 in men and 0.797-0.831 in women. The Globorisk-fatal model had the highest c-statistic in women (0.831, 95%CI 0.821-0.841), and the laboratory-based WHO-MI model in men (0.805, 95%CI 0.783-0.827). Despite this, all equations consistently overestimated CVD risk, particularly in women. Calibration analyses revealed systematic overprediction at higher risk levels, more pronounced in men. Recalibration of the Globorisk-fatal model improved agreement between predicted and observed risks, reducing overestimation. CONCLUSIONS: CVD risk models showed good discrimination but consistently overestimated risk in this Mexican cohort. The recalibrated Globorisk-fatal model improves risk estimation of fatal CVD in Mexican adults.","journal":"medRxiv","year":2025,"id":556747,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9366,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1110924,"name":"Daniel Ramírez‐García","orcid":"0000-0002-6899-246X","position":1,"is_corresponding":false},{"id":1237850,"name":"Juan Pablo Díaz-Sánchez","orcid":"0000-0002-2741-9237","position":2,"is_corresponding":false},{"id":1110926,"name":"Karime Berenice Carrillo-Herrera","orcid":"0009-0004-8645-5096","position":3,"is_corresponding":false},{"id":1110927,"name":"Leslie Alitzel Cabrera-Quintana","orcid":"0009-0005-4738-7593","position":4,"is_corresponding":false},{"id":1238210,"name":"Gael Dávila-López","orcid":null,"position":5,"is_corresponding":false},{"id":1110920,"name":"Carlos A. Fermín‐Martínez","orcid":"0000-0001-5627-8851","position":6,"is_corresponding":false},{"id":1456413,"name":"Andrea Malagón‐Liceaga","orcid":"0000-0002-7617-3915","position":7,"is_corresponding":false},{"id":1110922,"name":"Martín Roberto Basile-Álvarez","orcid":"0000-0003-0078-9710","position":8,"is_corresponding":false},{"id":620275,"name":"Jaime Berúmen","orcid":"0000-0001-6707-3317","position":9,"is_corresponding":false},{"id":620276,"name":"Pablo Kuri‐Morales","orcid":"0000-0002-0704-9507","position":10,"is_corresponding":false},{"id":1456414,"name":"Roberto Tapia‐Conyer","orcid":"0000-0001-9425-7322","position":11,"is_corresponding":false},{"id":620277,"name":"Jesús Alegre-Díaz","orcid":"0000-0001-9390-3871","position":12,"is_corresponding":false},{"id":251940,"name":"Jacqueline A. Seiglie","orcid":"0000-0001-9278-4516","position":13,"is_corresponding":false},{"id":982084,"name":"Neftali Eduardo Antonio‐Villa","orcid":"0000-0002-6879-1078","position":14,"is_corresponding":false},{"id":1110928,"name":"Omar Yaxmehen Bello‐Chavolla","orcid":"0000-0003-3093-937X","position":15,"is_corresponding":false},{"id":1110923,"name":"Jerónimo Perezalonso-Espinosa","orcid":"0009-0002-9774-1210","position":0,"is_corresponding":true}],"reference_count":30,"raw_metadata":null,"created_at":"2026-07-19T02:55:13.130091Z","pmid":"40963754","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}