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Cardiovascular disease risk assessment in older women: can we improve on Framingham? British Women’s Heart and Health prospective cohort study
  1. M May1,
  2. D A Lawlor1,
  3. P Brindle1,
  4. R Patel1,
  5. S Ebrahim2
  1. 1Department of Social Medicine, University of Bristol, Bristol, UK
  2. 2Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to:
    Margaret May
    Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK; m.t.may{at}bristol.ac.uk

Abstract

Objectives: To develop a cardiovascular risk assessment tool that is feasible and easy to use in primary care (general practice (GP) model).

Design: Prospective cohort study.

Setting: 23 towns in the United Kingdom.

Participants: 3582 women aged 60 to 79 years who were free of coronary heart disease (CHD) at entry into the British Women’s Heart and Health Study.

Main outcome measures: Predictive performance of a GP model compared with the standard Framingham model for both CHD and cardiovascular disease (CVD).

Results: The Framingham tool predicted CHD events over 5 years accurately (predicted 5.7%, observed 5.5%) but overpredicted CVD events (predicted 10.5%, observed 6.8%). In higher-risk groups, Framingham overpredicted both CHD and CVD events and was poorly calibrated for this cohort. Including C-reactive protein and fibrinogen with standard Framingham risk factors did not improve discrimination of the model. The GP model, which used age, systolic blood pressure, smoking habit and self-rated health (all of which can be easily obtained in one surgery visit) performed as well as the Framingham risk tool: area under the receiver operating curve discrimination statistic was 0.66 (95% confidence interval (CI) 0.62 to 0.70) for CHD and 0.67 (95% CI 0.64 to 0.71) for CVD compared with 0.65 (95% CI 0.61 to 0.68) and 0.66 (95% CI 0.62 to 0.69) for the corresponding Framingham models.

Conclusions: An alternative risk assessment based on only a simple routine examination and a small number of pertinent questions may be more useful in the primary care setting. This model appears to perform well but needs to be tested in different populations.

  • AUROC, area under the receiver operating characteristic curve
  • CHD, coronary heart disease
  • CVD, cardiovascular disease
  • GP, general practice

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Footnotes

  • Published Online First 17 March 2006

  • The British Women’s Heart and Health Study is funded by the UK Department of Health and British Heart Foundation. MM is funded by the British Heart Foundation and the Medical Research Council. DAL is funded by a UK Department of Health Career Scientist Award. The funding bodies have not influenced any aspects of the study design, analysis or interpretation of results. The views expressed in this publication are those of the authors and not necessarily those of any of the funding bodies.

  • Competing interests: None declared.

  • Contributions: Margaret May developed the study aim, undertook all statistical analyses and wrote the first draft of the paper. Debbie Lawlor co-directs the British Women’s Heart and Health Study, thought of and developed the study aim and contributed to writing the paper. Peter Brindle developed the study aim and contributed to writing the paper. Rita Patel managed the British Women’s Heart and Health Study database and contributed to writing the paper. Shah Ebrahim is the principal investigator of the British Women’s Heart and Health Study, thought of and developed the study aim and contributed to writing the paper.

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