BMJ  2003;327:619 (13 September), doi:10.1136/bmj.327.7415.619

Letter

Methods to identify increased risk of coronary disease in the general population

Conclusion is oversimplification

The first 150 words of the full text of this article appear below.

EDITOR—Wilson et al assert that measuring cholesterol concentration only in people of at least 50 efficiently identifies those at high risk of coronary heart disease.¹ This oversimplification results from a study with important defects.

Firstly, Wilson et al determined absolute risk of coronary heart disease by using the Sheffield tables and the underlying Framingham algorithm. However, in the German prospective cardiovascular Münster (PROCAM) study and the Augsburg cohort of the World Health Organization's monitoring trends and determinants in cardiovascular disease (MONICA) study, Framingham overestimated coronary risk about twofold.² Even allowing for the higher incidence of coronary heart disease in Britain compared with Germany,³ Wilson et al should have calculated risk by using either a British algorithm or a corrected Framingham formula.

Secondly, Wilson et al considered men and women together, even though risk of coronary heart disease in women is two to four times less than in age . . . [Full text of this article]

assmann@uni-muenster.de

Institute of Arteriosclerosis Research at the University of Muenster, Domagkstrasse 3, D-48149 Münster, Germany

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