The Framingham prediction rule is not valid in a European population of treated hypertensive patients

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Sylvie Bastuji-Garin1, Anne Deverly, Dominique Moyse

  • 1Department of Public Health, Henri-Mondor Hospital, (AP-HP), Paris XII University, Créteil, France. sylvie.bastuji-garin@hmn.ap-hop-paris.fr

Journal of Hypertension
|October 3, 2002
PubMed

Insights

The Framingham risk models overestimate coronary heart disease (CHD) risk in European populations. While stroke risk prediction was accurate, country-specific adjustments are needed for effective cardiovascular risk stratification.

Area of Science:

  • Cardiology
  • Epidemiology
  • Public Health

Background:

  • Cardiovascular risk stratification is crucial for primary prevention strategies.
  • Accurate risk assessment aids in tailoring preventative interventions for diverse populations.

Purpose of the Study:

  • To evaluate the accuracy of Framingham risk models in predicting coronary heart disease (CHD) and stroke in European hypertensive patients.
  • To assess the models' ability to rank individual cardiovascular risk levels.

Main Methods:

  • Prospective cohort study involving 4407 European patients (aged <75) without prior cardiovascular events from the INSIGHT trial.
  • Comparison of actual major cardiovascular events against risks predicted by Framingham equations and INSIGHT-derived models.
  • Follow-up median of 3.7 years across eight Western European countries and Israel.

Main Results:

  • Overestimation of absolute CHD risk by Framingham models was noted across all participating countries, with variations from 2% (UK) to 7% (France).
  • Predicted stroke risk closely aligned with actual observed stroke events.
  • A threefold higher cardiovascular event risk was observed in the highest risk quintile compared to the lowest within each country.

Conclusions:

  • Framingham models are not suitable for predicting absolute CHD risk in the overall European population.
  • Country-specific calibration and determination of risk cut-off points are recommended for utilizing Framingham models in European hypertensive patients.
Abstract

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