Curriculum in CardiologyPrediction of first coronary events with the Framingham score: A systematic review
Section snippets
Data sources
We systematically searched for studies of prediction rules for cardiovascular risk using electronic databases (Medline, EMBASE, BIOSIS, Cochrane library; from 1966 to August 2005; no language restriction). Validation studies of prediction rules are difficult to retrieve in electronic data bases because such studies are not indexed in a standardized manner. Thus, we used a sensitive search strategy not specific for the Framingham model but for cardiovascular prediction rules in general (see
Description of validation studies
Our searches retrieved 1496 potentially relevant studies (Figure 1). Seventeen validation studies of the Framingham risk score4, 5, 9, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25 with 25 independent prospective validation cohorts met the inclusion criteria (for excluded studies, see Appendix Table IV). Agreement between reviewers was high (chance adjusted κ statistics: 0.89).
Seventeen cohorts provided data for hard CHD or total CHD. One cohort reported CVD outcomes, of which 71% were
Discussion
The Framingham risk score is well calibrated to predict absolute risk for first coronary events in populations from the United States, Australia, and New Zealand. Mean predicted and observed population risk estimates are closely associated and show a high agreement. In European populations, overall agreement of predicted and observed absolute risk is poor due to substantial overestimation.
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The study was supported by the Helmut Horten Foundation. The funding source had no influence on study design; in the collection, analysis, and interpretation of the data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.