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Primary Care

Predictive accuracy of the Framingham coronary risk score in British men:prospective cohort study

BMJ 2003; 327 doi: (Published 27 November 2003) Cite this as: BMJ 2003;327:1267
  1. Peter Brindle, Wellcome training fellow in health services research (peter.brindle{at},
  2. Emberson Jonathan, research statistician2,
  3. Fiona Lampe, lecturer in medical statistics and epidemiology2,
  4. Mary Walker, senior lecturer in epidemiology2,
  5. Peter Whincup, professor of cardiovascular epidemiology3,
  6. Tom Fahey, professor of primary care medicine4,
  7. Shah Ebrahim, professor in epidemiology of ageing1
  1. 1Department of Social Medicine, University of Bristol, Bristol BS8 2PR
  2. 2Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London NW3 2PF
  3. 3Department of Community Health Sciences, St George's Hospital Medical School, London SW17 0RE
  4. 4Tayside Centre for General Practice, University of Dundee, Dundee DD2 4AD
  1. Correspondence to: P Brindle
  • Accepted 16 October 2003


Objective To establish the predictive accuracy of the Framingham risk score for coronary heart disease in a representative British population.

Design Prospective cohort study.

Setting 24 towns in the United Kingdom.

Participants 6643 British men aged 40-59 years and free from cardiovascular disease at entry into the British regional heart study.

Main outcome measures Comparison of observed 10 year coronary heart disease mortality and event rates with predicted rates for each individual, using the relevant Framingham risk equation.

Results Of 6643 men, 2.8% (95% confidence interval 2.4% to 3.2%) died from coronary heart disease compared with 4.1% predicted (relative overestimation 47%, P < 0.0001). A fatal or non-fatal coronary heart disease event occurred in 10.2% (9.5% to 10.9%) of the men compared with 16.0% predicted (relative overestimation 57%, P < 0.0001). These relative degrees of overestimation were similar at all levels of coronary heart disease risk, so that overestimation of absolute risk was greatest for those at highest risk. A simple adjustment provided an improved level of accuracy. In a “high risk score” approach, most cases occur in the low risk group. In this case, 84% of the deaths from coronary heart disease and non-fatal events occurred in the 93% of men classified at low risk (< 30% in 10 years) by the Framingham score.

Conclusion Guidelines for the primary prevention of coronary heart disease advocate offering preventive measures to individuals at high risk. Currently recommended risk scoring methods derived from the Framingham study significantly overestimate the absolute coronary risk assigned to individuals in the United Kingdom.


  • Contributors SE and TF developed the original idea for this study. PB drafted the paper and JE performed the analyses assisted by FL. PW and MW contributed to the design and execution of the British regional heart study. All authors contributed to the interpretation of data and the writing of the paper and have seen and approved the final version. PB and JE will act as guarantors for the paper.

  • Funding PB is funded by the Wellcome Trust. The views expressed here are those of the authors and not necessarily those of the funding agencies. The funding agencies had no role in the data collection or in the writing of this paper. The guarantors accept full responsibility for the conduct of the study, had access to the data, and controlled the decision to publish.

  • Competing interests None declared.

  • Ethical approval None required. 2003;327:1267

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