Predictive Value for the Chinese Population of the Framingham CHD Risk Assessment Tool Compared With the Chinese Multi-provincial Cohort Study
2004
ContextThe Framingham Heart Study helped to establish tools to assess coronary
heart disease (CHD) risk, but the homogeneous nature of the Framingham population
prevents simple extrapolation to other populations. Recalibration of Framingham
functions could permit various regions of the world to adapt Framingham tools
to local populations.ObjectiveTo evaluate the performance of the Framingham CHD risk functions, directly
and after recalibration, in a large Chinese population, compared with the
performance of the functions derived from the Chinese Multi-provincial Cohort
Study (CMCS).Design, Setting, and ParticipantsThe CMCS cohort included 30 121 Chinese adults aged 35 to 64 years
at baseline. Participants were recruited from 11 provinces and were followed
up for new CHD events from 1992 to 2002. Participants in the Framingham Heart
Study were 5251 white US residents of Framingham, Mass, who were 30 to 74
years old at baseline in 1971 to 1974 and followed up for 12 years.Main Outcome Measures"Hard" CHD (coronary death and myocardial infarction) was used as the
end point in comparisons of risk factors (age, blood pressure, smoking, diabetes,
total cholesterol, and high-density lipoprotein cholesterol [HDL-C]) as evaluated
by the CMCS functions, original Framingham functions, and recalibrated Framingham
functions.ResultsThe CMCS cohort had 191 hard CHD events and 625 total deaths vs 273
CHD events and 293 deaths, respectively, for Framingham. For most risk factor
categories, the relative risks for CHD were similar for Chinese and Framingham
participants, with a few exceptions (ie, age, total cholesterol of 200-239
mg/dL [5.18-6.19 mmol/L], and HDL-C less than 35 mg/dL [0.91 mmol/L] in men;
smoking in women). The discrimination using the Framingham functions in the
CMCS cohort was similar to the CMCS functions: the area under the receiver
operating characteristic curve was 0.705 for men and 0.742 for women using
the Framingham functions vs 0.736 for men and 0.759 for women using the CMCS
functions. However, the original Framingham functions systematically overestimated
the absolute CHD risk in the CMCS cohort. For example, in the 10th risk decile
in men, the predicted rate of CHD death was 20% vs an actual rate of 3%. Recalibration
of the Framingham functions using the mean values of risk factors and mean
CHD incidence rates of the CMCS cohort substantially improved the performance
of the Framingham functions in the CMCS cohort.ConclusionsThe original Framingham functions overestimated the risk of CHD for
CMCS participants. Recalibration of the Framingham functions improved the
estimates and demonstrated that the Framingham model is useful in the Chinese
population. For regions that have no established cohort, recalibration using
CHD rates and risk factors may be an effective method to develop CHD risk
prediction algorithms suited for local practice.
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