How generalizable are coronary risk prediction models? Comparison of Framingham and two national cohorts☆,☆☆,★
Section snippets
The Framingham Heart Study
The study was initiated in 1948 to investigate the factors associated with the development of cardiovascular disease in a representative sample of the adult population of Framingham, Massachusetts.13 A total of 5209 men and women 29 to 62 years of age were examined during the 4-year period of 1948 to 1952 and subsequently recalled for examinations every 2 years. The fourth examination, which took place during 1954 to 1958, was chosen as the baseline for the current report because the serum
Results
The baseline characteristics, number of CHD deaths, and age-adjusted mortality rates for the three cohorts are presented in Table I.Empty Cell Framingham (1954-1958) NHANES I (1971-1975) NHANES II (1976-1980) Mean SD Mean SD Mean SD Men No. at baseline 1846 2753 2655 Age (y) 49.6 8.5 53.2 10.5 54.3 10.5 Systolic blood pressure (mm Hg) 132.0 20.0 135.6 19.7 133.4 19.3 (133.7) (135.3) (132.6)
Discussion
The cohorts that were examined here, although sampled with entirely different strategies in different historical eras, provide evidence that the major risk factors are associated with CHD mortality rates among different populations and among men and women. The notable exception to this conclusion is smoking, in which heterogeneity was substantial. Despite heterogeneity in individual factors, when the risk factors were considered collectively, the ability of different models to rank individuals
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Supported by a grant from the National Heart, Lung, and Blood Institute (HL-58436).
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Reprint requests: Youlian Liao, MD, Department of Preventive Medicine and Epidemiology, Loyola University Stritch School of Medicine, 2160 S First Ave, Maywood, IL 60153.
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