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Framingham-Anderson

Derivation of prognostic modelAnderson et al. American Heart Journal 199148
Anderson et al. Circulation 199149
Location & dateFramingham USA 1968–1975
Population characteristicsAge 30–74
N=5573
46% Male, nearly 100 % white European extraction
Observational prospective community cohort
12 year follow up
Inclusion, co-morbiditySurvivors of Framingham cohort and the offspring of this cohort with all risk factor measurements available.
No previous CVD or cancer (other than basal cell carcinomas)
Risk factorsAge
Sex
Cholesterol/HDL ratio
Systolic blood pressure (average of 2 measures)
Diastolic blood pressure (average of 2 measures)
Smoking habit (current smoker or quit within last year)
Diabetes (treatment with insulin or oral agents, or fasting glucose ≥150mg/dl (original cohort), ≥140mg/dl (offspring)
LVH (ECG). If not done assume no LVH
Outcome
  1. MI (including silent and unrecognised MI)
  2. CHD death
  3. CHD (MI and CHD death, angina pectoris, coronary insufficiency)
  4. Stroke (including transient ischaemia
  5. CVD (1–4 plus CHF and PVD)
  6. CVD death
Prediction period4–12 years
Statistical methodsParametric statistical model: non-proportional hazards Weibull accelerated failure time model
PracticalRegression equation
Point scoring
Authors notesAll risk factors are required
Framingham Wolf equation preferable for stroke prediction (other risk factors included)
Family history of CHD should be considered
The predictions may not be appropriate for individuals with extremely elevated risk factors
Equations may not be directly applicable to populations with very low CHD incidence rates
Modifications, tools or guidelinesSee Table 4
External validationSee Table 9
Convergent validationSee Table 6
Trials of health outcomesSee Table 17

From: Appendix 3, Prognostic models or risk scoring methods for use in targeting primary prevention of cardiovascular diseases (part completed)

Cover of A Systematic Review of Risk Scoring Methods and Clinical Decision Aids Used in the Primary Prevention of Coronary Heart Disease (Supplement)
A Systematic Review of Risk Scoring Methods and Clinical Decision Aids Used in the Primary Prevention of Coronary Heart Disease (Supplement) [Internet].
NICE Clinical Guidelines, No. 67S.
Beswick AD, Brindle P, Fahey T, et al.
Copyright © 2008, Royal College of General Practitioners.

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