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European Heart Journal 2004 25(11):996-997; doi:10.1016/j.ehj.2004.02.032
Copyright © 2004 by the European Society of Cardiology.
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Letter to the Editor

Screening for cardiovascular disease: reply

J.-P Empana*

INSERM, U 508, 1, Rue du Pr Calmette, 59000 Lille, France

* Tel.: +33-1-45-59-51-00; Fax: +33-1-47-26-94-54
E-mail address: empana{at}vjf.inserm.fr

Dear Editor

Thank you for giving us the opportunity to reply to Dr AS Wierzbicki and please consider the present letter.

Dr Wierzbicki addressed two questions on the external validation study of the Framingham and PROCAM risk functions in healthy middle aged-men from low (France) and high-risk (Belfast) European countries.

First, the author raised the question of the impact of evolving definitions of categorical risk factors, wide variation in the interpretation of their definitions and lack of precision in biological risk factors measurements on the assessment of CHD risk. Most of these points have been discussed in our paper.1 The concern regarding the greater variability in the measurement of LDL-cholesterol (1998 algorithm)2 than in that of total cholesterol (1991 algorithm)3 is a priori well sounded. However, both 1991 and 1998 Framingham algorithms had only slightly different discriminatory power in our populations (-statistics of 0.68 and 0.69, respectively in Belfast and France for the 1991 algorithm as compared to 0.66 and 0.68 for the 1998 one). This suggests in practice that the variability in the measurement of LDL-cholesterol only partially contributed to the "quality" of the algorithms.

Second, the author pointed out the problem of the concordance between estimated individual's probability of CHD events and the actual outcomes. Although we did not develop this point in our paper, we gave -statistics (area under the receiving operative characteristics curve) at Table 4, which precisely represents this concordance for the different algorithms (Framingham and PROCAM) and populations (Belfast and France).

Finally, we agree with Dr Wierzbicki that individual risk calculation by algorithm may be largely spurious and should be interpreted critically in the light of clinical judgment.

References

  1. Empana JP, Ducimetiere P, Arveiler D, PRIME Study Group et al. Are the Framingham and PROCAM coronary heart disease risk functions applicable to different European populations? The PRIME Study. Eur. Heart J. 2003;24:1903–1911.[Abstract/Free Full Text]
  2. Wilson PW, D'Agostino RB, Levy D et al. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97:1837–1847.[Abstract/Free Full Text]
  3. Anderson KM, Wilson PW, Odell PM et al. An updated coronary risk profile. A statement for health professionals. Circulation. 1991;83:356–362.[Free Full Text]

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This Article
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