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In the Middle East, CHD is by far the most serious public health concern. More than nine million deaths are attributed to coronary heart disease (CHD) globally according to a 2016 World Health Organization report. Lowering the cutoff-point to 7.5% could improve the identification of patients for preventive treatment. The FRS can be used in the prediction of coronary risk among UAE nationals without diabetes, however, the recommended hCHD risk threshold for statin eligibility may be too high. While a 7.5% optimal cutoff-point improved the sensitivity to 74%. Applying the 20% high-risk threshold, the FRS model had a sensitivity of only 37% in identifying patients at high-risk for an hCHD event over 10 years. The FRS model displayed reasonably good discrimination (time-dependent AUROC value: 0.83) and calibration in predicting hCHD (Hosmer-Lemeshow χ 2 statistic 11.2, P = 0.191). During a median follow-up of 10.2 years (interquartile range, 7.8–11.0 years), 26 hCHD events occurred. The mean predicted FRS of the study cohort was 5.2% and approximately 7% were classified as high-risk (≥ 20% threshold) by the FRS model. The mean age was 48.0 ± 12.8 years and 45% were men. ResultsĪ total of 554 participants were included. The optimal cutoff-point for hCHD risk prediction was determined by ROC curve analysis. Calibration was measured by using the Hosmer-Lemeshow χ 2 test and the calibration curve. The area under the time-dependent receiver operating characteristic (ROC) curve (AUROC) was used to assess the FRS model discrimination. Follow-up data on hard CHD (hCHD) events (myocardial infarction or coronary death) for each participant were collected from the baseline visit in 2008 until December 31, 2019. They were aged 30–79 without a baseline history of cardiovascular disease and diabetes. This 10-year retrospective cohort study included patients from the primary care clinics and outpatient specialty departments of a large tertiary care hospital in Al-Ain, UAE. Therefore, this study aimed to examine the clinical performance of the FRS model for predicting 10-year CHD risk in adult United Arab Emirates (UAE) nationals without diabetes. However, the FRS model has never been validated in an Arab population. Primary prevention guidelines recommend the use of the Framingham risk score (FRS) to estimate the 10-year coronary heart disease (CHD) risk in patients without diabetes for statin eligibility.