EVIDENCE BASED PUBLIC HEALTH POLICY AND PRACTICE

¹ Unitat de Lípids i Epidemiologia Cardiovascular, Institut Municipal d’Investigació Mèdica (IMIM), Barcelona, Spain
² Institut Català de la Salut, Barcelona, Spain
³ Fundació Gol i Gurina and Institut Català de la Salut, Barcelona, Spain
⁴ Universitat Autònoma de Barcelona, Barcelona, Spain
⁵ Servei de Cardiologia i Unitat Coronària, Hospital de Girona Josep Trueta, Girona, Spain
⁶ Unitat Docent de Medicina de Familia de Girona, Institut Català de la Salut, Barcelona, Spain
⁷ Consorci Atenció Primària de l’Eixample, Universitat de Barcelona, Barcelona, Spain
⁸ Framingham Heart Study and Boston University, Boston, Massachusetts, USA

Correspondence to:
Correspondence to:
J Marrugat
Lípids and Cardiovascular Epidemiology Unit, Institut Municipal d’Investigació Mèdica (IMIM), Carrer Dr Aiguader, 88, 08003 Barcelona, Spain; jmarrugat{at}imim.es

Background: To assess the reliability and accuracy of the Framingham coronary heart disease (CHD) risk function adapted by the Registre Gironí del Cor (REGICOR) investigators in Spain.

Methods: A 5-year follow-up study was completed in 5732 participants aged 35–74 years. The adaptation consisted of using in the function the average population risk factor prevalence and the cumulative incidence observed in Spain instead of those from Framingham in a Cox proportional hazards model. Reliability and accuracy in estimating the observed cumulative incidence were tested with the area under the curve comparison and goodness-of-fit test, respectively.

Results: The Kaplan–Meier CHD cumulative incidence during the follow-up was 4.0% in men and 1.7% in women. The original Framingham function and the REGICOR adapted estimates were 10.4% and 4.8%, and 3.6% and 2.0%, respectively. The REGICOR-adapted function’s estimate did not differ from the observed cumulated incidence (goodness of fit in men, p = 0.078, in women, p = 0.256), whereas all the original Framingham function estimates differed significantly (p<0.001). Reliabilities of the original Framingham function and of the best Cox model fit with the study data were similar in men (area under the receiver operator characteristic curve 0.68 and 0.69, respectively, p = 0.273), whereas the best Cox model fitted better in women (0.73 and 0.81, respectively, p<0.001).

Conclusion: The Framingham function adapted to local population characteristics accurately and reliably predicted the 5-year CHD risk for patients aged 35–74 years, in contrast with the original function, which consistently overestimated the actual risk.

Abbreviations: AMI, acute myocardial infarction; CHD, coronary heart disease; ECG, electrocardiogram; HDL, high-density lipoprotein; REGICOR, Registre Gironí del Cor; VERIFICA, Validez de la Ecuación de Riesgo Individual de Framingham de Incidentes Coronarios Adaptada (Validity of the Adapted Framingham Individual Risk Equation for Coronary Incidents)

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