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Heart 1999;81:40-46 ( January )
Section of Clinical
Pharmacology and Therapeutics, Department of Medicine and Pharmacology,
University of Sheffield, Sheffield, UK
Correspondence to: Professor L E Ramsay, Section of Clinical Pharmacology and Therapeutics, Department of Medicine and Pharmacology, Floor L, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK. email: d.colley{at}sheffield.ac.uk
Accepted for publication 10 September 1998
Objective
To examine
the validity of estimates of coronary heart disease (CHD) risk by the
Framingham risk function, for European populations.
DesignComparison of
CHD risk estimates for individuals derived from the Framingham,
prospective cardiovascular Münster (PROCAM), Dundee, and British
regional heart (BRHS) risk functions.
SettingSheffield
Hypertension Clinic.
Patients206 consecutive hypertensive men
aged 35-75 years without preexisting vascular disease.
ResultsThere was
close agreement among the Framingham, PROCAM, and Dundee risk functions
for average CHD risk. For individuals the best correlation was between
Framingham and PROCAM, both of which use high density lipoprotein (HDL)
cholesterol. When Framingham was used to target a CHD event rate
> 3% per year, it identified men with mean CHD risk by PROCAM of
4.6% per year and all had CHD event risks > 1.5% per year. Men at
lower risk by Framingham had a mean CHD risk by PROCAM of 1.5% per
year, with 16% having a CHD event risk > 3.0% per year. BRHS risk
function estimates of CHD risk were fourfold lower than those for the
other three risk functions, but with moderate correlations, suggesting
an important systematic error.
ConclusionThere is
close agreement between the Framingham, PROCAM, and Dundee risk
functions as regards average CHD risk, and moderate agreement for
estimates within individuals. Taking PROCAM as the external standard,
the Framingham function separates high and low CHD risk groups and is
acceptably accurate for northern European populations, at least in men.
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