Heart 1999;81:40-46 ( January )

Is the Framingham risk function valid for northern European populations? A comparison of methods for estimating absolute coronary risk in high risk men

I U Haq, L E Ramsay, W W Yeo, P R Jackson, E J Wallis

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

ObjectiveTo 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.

Keywords: ischaemic heart disease;  prevention;  risk factors

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© 1999 by Heart
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