Validation of the Framingham coronary heart disease prediction scores

Results of a multiple ethnic groups investigation

Ralph B. D'Agostino, Scott M Grundy, Lisa M. Sullivan, Peter Wilson

Research output: Contribution to journalArticle

1465 Citations (Scopus)

Abstract

Context: The Framingham Heart Study produced sex-specific coronary heart disease (CHD) prediction functions for assessing risk of developing incident CHD in a white middle-class population. Concern exists regarding whether these functions can be generalized to other populations. Objective: To test the validity and transportability of the Framingham CHD prediction functions per a National Heart, Lung, and Blood Institute workshop organized for this purpose. Design, Setting, and Subjects: Sex-specific CHD functions were derived from Framingham data for prediction of coronary death and myocardial infarction. These functions were applied to 6 prospectively studied, ethnically diverse cohorts (n=23424), including whites, blacks, Native Americans, Japanese American men, and Hispanic men: the Atherosclerosis Risk in Communities Study (1987-1988), Physicians' Health Study (1982), Honolulu Heart Program (1980-1982), Puerto Rico Heart Health Program (1965-1968), Strong Heart Study (1989-1991), and Cardiovascular Health Study (1989-1990). Main Outcome Measures: The performance, or ability to accurately predict CHD risk, of the Framingham functions compared with the performance of risk functions developed specifically from the individual cohorts' data. Comparisons included evaluation of the equality of relative risks for standard CHD risk factors, discrimination, and calibration. Results: For white men and women and for black men and women the Framingham functions performed reasonably well for prediction of CHD events within 5 years of follow-up. Among Japanese American and Hispanic men and Native American women, the Framingham functions systematically overestimated the risk of 5-year CHD events. After recalibration, taking into account different prevalences of risk factors and underlying rates of developing CHD, the Framingham functions worked well in these populations. Conclusions: The sex-specific Framingham CHD prediction functions perform well among whites and blacks in different settings and can be applied to other ethnic groups after recalibration for differing prevalences of risk factors and underlying rates of CHD events.

Original languageEnglish (US)
Pages (from-to)180-187
Number of pages8
JournalJournal of the American Medical Association
Volume286
Issue number2
StatePublished - 2001

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Ethnic Groups
Coronary Disease
Asian Americans
North American Indians
Hispanic Americans
Health
National Heart, Lung, and Blood Institute (U.S.)
Puerto Rico
Social Class
Calibration
Population
Atherosclerosis
Myocardial Infarction
Outcome Assessment (Health Care)
Physicians
Education

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Validation of the Framingham coronary heart disease prediction scores : Results of a multiple ethnic groups investigation. / D'Agostino, Ralph B.; Grundy, Scott M; Sullivan, Lisa M.; Wilson, Peter.

In: Journal of the American Medical Association, Vol. 286, No. 2, 2001, p. 180-187.

Research output: Contribution to journalArticle

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