Framingham risk function overestimates risk of coronary heart disease in men and women from Germany -: results from the MONICA Augsburg and the PROCAM cohorts
Framingham risk function overestimates risk of coronary heart disease in men and women from Germany -: results from the MONICA Augsburg and the PROCAM cohorts
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DOI：
10.1016/s0195-668x(03)00081-2
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发表时间：
2003-05-01
影响因子：
39.3
通讯作者：
Keil, U
中科院分区：
文献类型：
--
作者：
Hense, HW;Schulte, H;Keil, U
背景冠心病（CHD）绝对危险度的预测通常是基于来自心脏研究的危险度预测方程。然而，人口风险水平的差异损害了这些风险函数的外部有效性。对来自MONICA Augsburg（2861名男性和2925名女性）和PROCAM（5527名男性和3155名女性）队列的35-64岁参与者进行了非致死性心肌梗死（MI）和致死性冠状动脉事件随访。对于每个参与者，使用Fragrance风险方程推导出致命性和非致命性事件的预测绝对风险。将预测风险与实际观察风险进行比较。两个队列的基线特征相似。无论性别如何，Fragrance风险函数预测的冠状动脉风险大大超过了德国队列中实际观察到的风险。白色人的预测和观察到的绝对CHID风险之间的差异随着年龄的增长而增加，预测与观察到的风险之比保持恒定，约为2。考虑到德国队列中由于未识别的MI和猝死而导致的潜在不确定性，Fragrance风险函数高估的剩余风险可能至少为50%.Conclusions当地有风险因素的患者管理指南需要纠正这种高估，以避免不充分的治疗和一级预防费用的膨胀。应在其他人群中进行类似的研究，目的是确定适当的因素，将绝对风险预测校准到当地人群CHD风险水平。(C)2003年欧洲心脏病学会。由爱思唯尔科技有限公司出版。保留所有权利。
Background The prediction of the absolute risk of coronary heart disease (CHD) is commonly based on risk prediction equations that originate from the Framingham Heart Study. However, differences in population risk levels compromise the external validity of these risk functions.Setting and study population. Participants aged 35-64 years from the MONICA Augsburg (2861 men and 2925 women) and the PROCAM (5527 men and 3155 women) cohorts were followed-up with regard to incident non-fatal myocardial infarction (MI) and fatal coronary events. For each participant, the predicted absolute risk of fatal plus non-fatal events was derived using Framingham risk equations. Predicted and actually observed risks were compared.Results. The two cohorts were similar in their baseline characteristics. Coronary risk predicted by the Framingham risk function substantially exceeded the risk actually observed in the German cohorts, irrespective of gender. The difference between predicted and observed absolute CHID risk increased with age white the ratio of predicted over observed risk remained constant at about a value of 2. Taking potentials for underascertainment in the German cohorts due to unrecognised MI and sudden deaths into account, the residual magnitude of risk overestimation by the Framingham risk function is probably at least 50%.Conclusions Local guidelines for the management of patients with risk factors need to correct for this overestimation to avoid inadequate initiation of treatment and inflation of costs in primary prevention. Similar studies should be conducted in other populations with the aim of defining appropriate factors that calibrate absolute risk predictions to local population levels of CHD risk. (C) 2003 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.