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Validity of an adaptation of the Framingham cardiovascular risk function: the VERIFICA study
  1. Jaume Marrugat1,
  2. Isaac Subirana1,
  3. Eva Comín2,
  4. Carmen Cabezas3,
  5. Joan Vila1,
  6. Roberto Elosua1,
  7. Byung-Ho Nam8,
  8. Rafel Ramos1,
  9. Joan Sala5,
  10. Pascual Solanas4,
  11. Ferran Cordón4,6,
  12. Joan Gené-Badia7,
  13. Ralph B D’Agostino8,
  14. for the VERIFICA (Validez de la Ecuación de Riesgo Individual de Framingham de Incidentes Coronarios Adaptada*) Investigators
  1. 1Unitat de Lípids i Epidemiologia Cardiovascular, Institut Municipal d’Investigació Mèdica (IMIM), Barcelona, Spain
  2. 2Institut Català de la Salut, Barcelona, Spain
  3. 3Fundació Gol i Gurina and Institut Català de la Salut, Barcelona, Spain
  4. 4Universitat Autònoma de Barcelona, Barcelona, Spain
  5. 5Servei de Cardiologia i Unitat Coronària, Hospital de Girona Josep Trueta, Girona, Spain
  6. 6Unitat Docent de Medicina de Familia de Girona, Institut Català de la Salut, Barcelona, Spain
  7. 7Consorci Atenció Primària de l’Eixample, Universitat de Barcelona, Barcelona, Spain
  8. 8Framingham Heart Study and Boston University, Boston, Massachusetts, USA
  1. Correspondence to:
 J Marrugat
 Lípids and Cardiovascular Epidemiology Unit, Institut Municipal d’Investigació Mèdica (IMIM), Carrer Dr Aiguader, 88, 08003 Barcelona, Spain; jmarrugat{at}


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.

  • 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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  • A full roster of the VERIFICA Investigators is provided in the appendix and at

  • Funding: This study was funded in part by the Institut Municipal d’Investigació Mèdica (IMIM), Institut Català de la Salut, Fundació Gol i Gurina’ and by an educational grant from the Esteve Group, all in Barcelona, Spain. The study was also partially funded by the following Spanish Fondo de Investigación Sanitaria research networks: RECAVA (grant FIS C03/01), RCESP (grant FIS C03/09), REDIAPP-Catalunya (grant FIS G03/170) and HERACLES (grant FIS G03/045).

  • Competing interests: None declared.

  • Members of the scientific committee: Jaume Marrugat (PI), Carles Brotons, Carmen Cabezas, Joan Josep Cabré, Arantxa Catalán, Ramon Ciurana, Eva Comín, Ferran Cordón, Joan Gené-Badia, Rafael Masiá, Ramon Morera, Clara Pujol, Rafel Ramos, Joan Sala, Pascual Solanas, Maria-Concepció Violan.

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