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Research Article

Performance of the Framingham and SCORE cardiovascular risk prediction functions in a non-diabetic population of a Spanish health care centre: a validation study

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Pages 242-248 | Received 15 May 2009, Accepted 18 Aug 2010, Published online: 27 Sep 2010
 

Abstract

Objective. To analyse the 10-year performance of the original Framingham coronary risk function and of the SCORE cardiovascular death risk function in a non-diabetic population of 40–65 years of age served by a Spanish healthcare centre. Also, to estimate the percentage of patients who are candidates for antihypertensive and lipid-lowering therapy. Design. Longitudinal, observational study of a retrospective cohort followed up for 10 years. Setting. Primary care health centre. Patients. A total of 608 non-diabetic patients of 40–65 years of age (mean 52.8 years, 56.7% women), without evidence of cardiovascular disease were studied. Main outcome measures. Coronary risk at 10 years from the time of their recruitment, using the tables based on the original Framingham function, and of their 10-year risk of fatal cardiovascular disease using the SCORE tables. Results. The actual incidence rates of coronary and fatal cardiovascular events were 7.9% and 1.5%, respectively. The original Framingham equation over-predicted risk by 64%, while SCORE function over-predicted risk by 40%, but the SCORE model performed better than the Framingham one for discrimination and calibration statistics. The original Framingham function classified 18.3% of the population as high risk and SCORE 9.2%. The proportions of patients who would be candidates for lipid-lowering therapy were 31.0% and 23.8% according to the original Framingham and SCORE functions, respectively, and 36.8% and 31.2% for antihypertensive therapy. Conclusion. The SCORE function showed better values than the original Framingham function for each of the discrimination and calibration statistics. The original Framingham function selected a greater percentage of candidates for antihypertensive and lipid-lowering therapy.

Acknowledgments

The authors would like to thank Agustín García-Nogales (Professor of Biostatistics at the University of Extremadura, Badajoz, Spain) for his expert help with Brier score estimations.

Funding

This study was funded by redIAPP (Innovation and Integration of Prevention and Health Promotion in Primary Care), thematic cooperative research network G03/170 and by a grant from the Programme for Promotion of Research in Primary Care, of the Instituto de Salud Carlos III. The first and fifth authors of the article also received a predoctoral scholarship from the Spanish Society of Family and Community Medicine.

Conflicts of interest: None