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. 2003 Nov 29;327(7426):1267.
doi: 10.1136/bmj.327.7426.1267.

Predictive accuracy of the Framingham coronary risk score in British men: prospective cohort study

Peter Brindle  1 , Jonathan Emberson, Fiona Lampe, Mary Walker, Peter Whincup, Tom Fahey, Shah Ebrahim
Affiliations

Predictive accuracy of the Framingham coronary risk score in British men: prospective cohort study

Peter Brindle et al. BMJ. .

Abstract

Objective: To establish the predictive accuracy of the Framingham risk score for coronary heart disease in a representative British population.

Design: Prospective cohort study.

Setting: 24 towns in the United Kingdom.

Participants: 6643 British men aged 40-59 years and free from cardiovascular disease at entry into the British regional heart study.

Main outcome measures: Comparison of observed 10 year coronary heart disease mortality and event rates with predicted rates for each individual, using the relevant Framingham risk equation.

Results: Of 6643 men, 2.8% (95% confidence interval 2.4% to 3.2%) died from coronary heart disease compared with 4.1% predicted (relative overestimation 47%, P < 0.0001). A fatal or non-fatal coronary heart disease event occurred in 10.2% (9.5% to 10.9%) of the men compared with 16.0% predicted (relative overestimation 57%, P < 0.0001). These relative degrees of overestimation were similar at all levels of coronary heart disease risk, so that overestimation of absolute risk was greatest for those at highest risk. A simple adjustment provided an improved level of accuracy. In a "high risk score" approach, most cases occur in the low risk group. In this case, 84% of the deaths from coronary heart disease and non-fatal events occurred in the 93% of men classified at low risk (< 30% in 10 years) by the Framingham score.

Conclusion: Guidelines for the primary prevention of coronary heart disease advocate offering preventive measures to individuals at high risk. Currently recommended risk scoring methods derived from the Framingham study significantly overestimate the absolute coronary risk assigned to individuals in the United Kingdom.

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Figures

Fig 1
Fig 1
Ten year predicted versus observed coronary heart disease mortality with 95% confidence intervals by quintile of Framingham risk, systolic blood pressure, total to high density lipoprotein cholesterol ratio, and age
Fig 2
Fig 2
Ten year predicted versus observed coronary heart disease event rates with 95% confidence intervals by quintile of Framingham risk, systolic blood pressure, total to high density lipoprotein cholesterol ratio, and age
Fig 3
Fig 3
Predicted coronary heart disease death and coronary heart disease event risks before and after recalibration with observed 10 year rates
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Comment in

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