Are the Framingham and PROCAM coronary heart disease risk functions applicable to different European populations? The PRIME Study

• Published in: European heart journal Vol. 24; no. 21; pp. 1903 - 1911
• Main Author: Empana, J
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.11.2003
• Subjects: Adult; Aged; Angina Pectoris - etiology; Angina Pectoris - mortality; Biological and medical sciences; Cardiology. Vascular system; Cohort Studies; Coronary Disease - etiology; Coronary Disease - mortality; Coronary heart disease; France - epidemiology; Heart; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - epidemiology; Myocardial Infarction - mortality; Northern Ireland - epidemiology; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Prospective Studies; Risk Assessment - standards; Risk Factors; Sensitivity and Specificity; Europe; France; Northern Ireland; Human; Infarct; Primary prevention; Risk factor; Myocardium; Extenial validation; Cardiovascular disease; Risk function; Coronary heart disease; Myocardial disease; Epidemiology
• ISSN: 0195-668X
• DOI: 10.1016/j.ehj.2003.09.002

To assess whether the Framingham and PROCAM risk functions were applicable to men in Belfast and France. We performed an external validation study within the PRIME (Prospective Epidemiological Study of Myocardial Infarction) cohort study. It comprised men recruited in Belfast (2399) and France (7359) who were aged 50 to 59 years, free of CHD at baseline (1991 to 1993) and followed over 5 years for CHD events (coronary death, myocardial infarction, angina pectoris). We compared the relative risks of CHD associated with the classic risk factors in PRIME with those in Framingham and PROCAM cohorts. We then compared the number of predicted and observed 5-year CHD events (calibration). Finally, we estimated the ability of the risk functions to separate high risk from low risk subjects (discrimination). The relative risk of CHD calculated for the various factors in the PRIME population were not statistically different from those published in the Framingham and PROCAM risk functions. The number of CHD events predicted by these risk functions however clearly overestimated those observed in Belfast and France. The two risk functions had a similar ability to separate high risk from low risk subjects in Belfast and France (c-statistic range: 0.61-0.68). The Framingham and PROCAM risk functions should not be used to estimate the absolute CHD risk of middle-aged men in Belfast and France without any CHD history because of a clear overestimation. Specific population risk functions are needed.