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Application of the updated Framingham risk score to Japanese men
M Suka1, H Sugimori, K Yoshida
1Department of Preventive Medicine, St. Marianna University School of Medicine, Kanagawa, Japan. suka@marianna-u.ac.jp
Insights
The updated Framingham risk score reasonably ranks coronary heart disease (CHD) risk in Japanese men. This tool accurately identifies high-risk individuals, though further validation in Japanese populations is recommended.
Area of Science:
- Cardiovascular Epidemiology
- Preventive Cardiology
Background:
- Limited availability of validated coronary heart disease (CHD) risk assessment tools in Japan.
- Need for evaluating existing risk scores in diverse populations.
Purpose of the Study:
- To assess the validity of the updated Framingham risk score for predicting CHD in a Japanese male population.
- To determine the score's accuracy in identifying high-risk individuals.
Main Methods:
- Analysis of an annual health examination database from a Japanese company.
- Follow-up of 5,611 male subjects (aged 30-59) for 5-7 years to observe CHD incidence.
- Utilized Framingham point score for individual risk assessment and receiver operating characteristic (ROC) analysis.
Main Results:
- The Framingham point score was significantly higher in CHD cases (n=80) than non-CHD cases (n=5,531).
- CHD incidence increased progressively with higher Framingham point scores.
- ROC analysis yielded an area under the curve of 0.71, with optimal discrimination at 6 points (sensitivity 0.59, specificity 0.74).
Conclusions:
- The updated Framingham risk score provides a reasonable rank ordering of CHD risk and identifies high-risk Japanese men with considerable accuracy.
- Relative risks for factors like hypertension and smoking differed between Japanese and Framingham populations, suggesting potential need for coefficient re-evaluation.
- Further studies are recommended to refine the risk scoring model for Japanese populations.
Abstract:
Few tools for risk assessment of coronary heart disease (CHD) have yet been made available in Japan. This study aims to examine the validity of the updated Framingham risk score as applied to a Japanese male population. Using the annual health examination database of a Japanese company, we followed-up 5,611 male subjects, aged 30 to 59 years, who had initially recorded neither history of cardiovascular disease nor electrocardiographical ischemic changes, in order to observe the occurrence of CHD over a period of 5 to 7 years. The total score calculated by the Framingham risk score sheet (the Framingham point score) was used as an indicator of CHD risk for the subject individually. The mean of the Framingham point score for 80 CHD cases was significantly higher than that for 5,531 non-CHD cases. The incidence of CHD gradually increased with the Framingham point score. In the receiver operating characteristic analysis, the area under the curve reached 0.71. At 6 points, the curve came closest to the upper left-hand corner, with a specificity of 0.74 and sensitivity of 0.59. On the other hand, multivariable-adjusted relative risks associated with old age, high blood pressure, low HDL cholesterol and smoking in the Japanese male population were different from those in the Framingham population. Despite the low incidence of CHD, the updated Framingham risk score could provide a reasonable rank ordering of CHD risk and could identify Japanese men (and possible other individuals) at high risk for CHD with considerable accuracy. However, further study of Japanese populations may be required to reappraise several coefficients of risk factor in the risk scoring model.