Copyright © 2003 by the European Society of Cardiology.
Clinical research
Are the Framingham and PROCAM coronary heart disease risk functions applicable to different European populations?
The PRIME Study
a Lille MONICA Project, INSERM U508, Institut Pasteur de Lille, Lille, France
b France MONICA Project Coordinating Centre, INSERM U258, Paul Brousse Hospital, Villejuif, France
c Strasbourg MONICA Project, Department of Epidemiology and Public Health, Medical School of Strasbourg, Strasbourg, France
d Toulouse MONICA Project, INSERM U558, Medical School of Purpan, Purpan, France
e Belfast MONICA Project, Department of Epidemiology and Public Health, Queen’s University Belfast, UK
* Corresponding author. Dr J-P. Empana, INSERM, U 508, 1, rue du Pr Calmette, 59000 Lille, Nord, France. Tel.: +33-1-45-59-51-00; fax: +33-1-47-26-94-54
E-mail address: empana{at}vjf.inserm.fr
Received 14 February 2003; revised 21 August 2003; accepted 5 September 2003
Abstract
Aims To assess whether the Framingham and PROCAM risk functions were applicable to men in Belfast and France.
Methods and results 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).
Conclusion 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.
Key Words: Epidemiology • Primary prevention • Coronary heart disease • Risk function • External validation
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