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J Hypertens. 2002 Oct;20(10):1973-80.

The Framingham prediction rule is not valid in a European population of treated hypertensive patients.

Author information

  • 1Department of Public Health, Henri-Mondor Hospital, (AP-HP), Paris XII University, Créteil, France. sylvie.bastuji-garin@hmn.ap-hop-paris.fr

Abstract

BACKGROUND:

Stratification of population groups according to cardiovascular risk level is recommended for primary prevention.

OBJECTIVE:

To assess whether the Framingham models could accurately predict the absolute risk of coronary heart disease (CHD) and stroke in a large cohort of middle-aged European patients with hypertension, and rank individual patients according to actual risk.

DESIGN:

A prospective cohort study comparing the actual risk with that predicted by either the Framingham equations or models derived from the INSIGHT study.

PATIENTS AND SETTING:

From the INSIGHT prospective trial, conducted in eight countries of Western Europe and Israel, we selected 4407 European patients younger than 75 years without previous cardiovascular events.

INTERVENTIONS:

None.

MAIN OUTCOME MEASURES:

Major cardiovascular events.

RESULTS:

In this population (45% men, mean age 64.1 years), 124 (2.8%) patients had CHD and 96 (2.2%) had strokes after a median follow-up of 3.7 years. Overestimation of absolute CHD risk by the Framingham equation was observed in all countries (from 2% in the UK to 7% in France), whereas predicted risk of stroke was close to the actual risk. However, patients in the highest risk quintile within each country had a threefold greater risk of a cardiovascular event than those in the lowest quintile.

CONCLUSIONS:

The Framingham models should not be used to predict absolute CHD risk in the European population as a whole. However, these models may be used within each country, provided that cut-off points defining high-risk patients have been determined within each country.

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PMID:
12359975
[PubMed - indexed for MEDLINE]
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