• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of jepicomhJournal of Epidemiology and Community HealthVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
J Epidemiol Community Health. Aug 2003; 57(8): 634–638.
PMCID: PMC1732543

An adaptation of the Framingham coronary heart disease risk function to European Mediterranean areas


Aim: To determine whether the Framingham function accurately predicts the 10 year risk of coronary disease and to adapt this predictive method to the characteristics of a Spanish population.

Method and Results: A Framingham function for predicting 10 year coronary deaths and non-fatal myocardial infarction was applied to the population of the province of Gerona, Spain, where the cumulated incidence rate of myocardial infarction has been determined since 1988 by a specific registry. The prevalence of cardiovascular risk factors in this region of Spain was established in 1995 by a cross sectional study on a representative sample of 1748 people. The number of cases estimated by the Framingham function for 10 year coronary deaths and non-fatal myocardial infarction was compared with that observed. The Framingham function estimated 2425 coronary heart disease cases in women and 1181 were observed. In men, 9919 were estimated and 3706 were observed. Recalibrating the Framingham equations to the event rate and the prevalence of the risk factors in Gerona led to estimates very close to the number of cases observed in Gerona men and women.

Conclusions: The Framingham function estimates more than doubled the actual risk of coronary disease observed in north east Spain. After calibration, the Framingham function became an effective method of estimating the risk in this region with low coronary heart disease incidence.

Full Text

The Full Text of this article is available as a PDF (135K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Pérez G, Pena A, Sala J, Roset P, Masiá R, Marrugat J. Acute myocardial infarction case fatality, incidence and mortality rates in a population registry in Gerona, Spain, 1990-1992. REGICOR Investigators. Int J Epidemiol. 1998 Aug;27(4):599–604. [PubMed]
  • Artaud-Wild SM, Connor SL, Sexton G, Connor WE. Differences in coronary mortality can be explained by differences in cholesterol and saturated fat intakes in 40 countries but not in France and Finland. A paradox. Circulation. 1993 Dec;88(6):2771–2779. [PubMed]
  • Tunstall-Pedoe H, Kuulasmaa K, Amouyel P, Arveiler D, Rajakangas AM, Pajak A. Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation. 1994 Jul;90(1):583–612. [PubMed]
  • Masiá R, Pena A, Marrugat J, Sala J, Vila J, Pavesi M, Covas M, Aubó C, Elosua R. High prevalence of cardiovascular risk factors in Gerona, Spain, a province with low myocardial infarction incidence. REGICOR Investigators. J Epidemiol Community Health. 1998 Nov;52(11):707–715. [PMC free article] [PubMed]
  • Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998 May 12;97(18):1837–1847. [PubMed]
  • Kannel WB, Larson M. Long-term epidemiologic prediction of coronary disease. The Framingham experience. Cardiology. 1993;82(2-3):137–152. [PubMed]
  • Wallis EJ, Ramsay LE, Ul Haq I, Ghahramani P, Jackson PR, Rowland-Yeo K, Yeo WW. Coronary and cardiovascular risk estimation for primary prevention: validation of a new Sheffield table in the 1995 Scottish health survey population. BMJ. 2000 Mar 11;320(7236):671–676. [PMC free article] [PubMed]
  • Verschuren WM, Jacobs DR, Bloemberg BP, Kromhout D, Menotti A, Aravanis C, Blackburn H, Buzina R, Dontas AS, Fidanza F, et al. Serum total cholesterol and long-term coronary heart disease mortality in different cultures. Twenty-five-year follow-up of the seven countries study. JAMA. 1995 Jul 12;274(2):131–136. [PubMed]
  • van den Hoogen PC, Feskens EJ, Nagelkerke NJ, Menotti A, Nissinen A, Kromhout D. The relation between blood pressure and mortality due to coronary heart disease among men in different parts of the world. Seven Countries Study Research Group. N Engl J Med. 2000 Jan 6;342(1):1–8. [PubMed]
  • D'Agostino RB, Sr, Grundy S, Sullivan LM, Wilson P. Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation. JAMA. 2001 Jul 11;286(2):180–187. [PubMed]
  • Grundy SM, Balady GJ, Criqui MH, Fletcher G, Greenland P, Hiratzka LF, Houston-Miller N, Kris-Etherton P, Krumholz HM, LaRosa J, et al. Primary prevention of coronary heart disease: guidance from Framingham: a statement for healthcare professionals from the AHA Task Force on Risk Reduction. American Heart Association. Circulation. 1998 May 12;97(18):1876–1887. [PubMed]
  • Haq IU, Jackson PR, Yeo WW, Ramsay LE. Sheffield risk and treatment table for cholesterol lowering for primary prevention of coronary heart disease. Lancet. 1995 Dec 2;346(8988):1467–1471. [PubMed]
  • Ramsay LE, Haq IU, Jackson PR, Yeo WW, Pickin DM, Payne JN. Targeting lipid-lowering drug therapy for primary prevention of coronary disease: an updated Sheffield table. Lancet. 1996 Aug 10;348(9024):387–388. [PubMed]
  • Jackson R. Updated New Zealand cardiovascular disease risk-benefit prediction guide. BMJ. 2000 Mar 11;320(7236):709–710. [PMC free article] [PubMed]
  • Menotti A, Puddu PE, Lanti M. Comparison of the Framingham risk function-based coronary chart with risk function from an Italian population study. Eur Heart J. 2000 Mar;21(5):365–370. [PubMed]
  • Ordovas JM. Colesterol y tabaco: clásicos que perduran en el tiempo. Rev Esp Cardiol. 2001 Oct;54(10):1143–1145. [PubMed]
  • Dobson AJ, Evans A, Ferrario M, Kuulasmaa KA, Moltchanov VA, Sans S, Tunstall-Pedoe H, Tuomilehto JO, Wedel H, Yarnell J. Changes in estimated coronary risk in the 1980s: data from 38 populations in the WHO MONICA Project. World Health Organization. Monitoring trends and determinants in cardiovascular diseases. Ann Med. 1998 Apr;30(2):199–205. [PubMed]
  • Tomás-Abadal L, Varas-Lorenzo C, Bernades-Bernat E, Balaguer-Vintró I. Coronary risk factors and a 20-year incidence of coronary heart disease and mortality in a Mediterranean industrial population. The Manresa Study, Spain. Eur Heart J. 1994 Aug;15(8):1028–1036. [PubMed]
  • Kannel WB. Silent myocardial ischemia and infarction: insights from the Framingham Study. Cardiol Clin. 1986 Nov;4(4):583–591. [PubMed]
  • Sytkowski PA, D'Agostino RB, Belanger A, Kannel WB. Sex and time trends in cardiovascular disease incidence and mortality: the Framingham Heart Study, 1950-1989. Am J Epidemiol. 1996 Feb 15;143(4):338–350. [PubMed]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...