GRUNDY
ET AL., Assessment of Cardiovascular Risk
J Am Coll Cardiol 1999;34:1348--59
AHA/ACC
Scientific Statement: Assessment of Cardiovascular Risk
by Use of Multiple-Risk-Factor Assessment Equations
A
Statement for Healthcare Professionals From the American
Heart Association and the American College of Cardiology
XIII.
Certain Limitations of Framingham Database
Certain
features of the Framingham scores reflect limitations
of the data set. For example, LDL-C and HDL-C levels are
known to be continuous in their correlation with CHD risk.
Presumably because of an insufficient number of subjects
in all categories, these continuous relationships are
not consistently observed between each incremental category.2
Moreover, the assigned scores for each category are not
entirely consistent with the notations for graded risk
proposed by the NCEP6
and the JNC.7
Framingham scores probably require adjustment to account
for the continuous relationship between risk factors and
CHD.6,7
As stated previously, this adjustment was made in Table
4. Finally, there is no indication that Framingham
scoring has been corrected for regression dilution bias;41
this bias results from the random fluctuation of risk
factors over time such that single measures of risk factors
systematically underestimate the association between risk
factors and CHD.
Prediction
scores from Framingham illustrate the substantial difference
in CHD risk between men and women before age 70. The
difference between men and women particularly stands
out for hard CHD end points. The diagnosis of angina
contributes a sizable fraction of all CHD end points
in middle-aged women and accounts for the notable difference
between total CHD and hard CHD in this age group. Nonatherosclerotic
anginal syndromes may have been mislabeled among total
CHD end points in some Framingham women. The relatively
small rise in risk for total CHD events after age 55
should not obscure the progressive increase in risk
for hard CHD in older women. Framingham findings on
hard end points are more consistent with population
studies that show a sharp rise in CHD morbidity and
mortality in women after age 70. Even so, a discrepancy
in CHD risk between men and women persists throughout
all age groups.
Copyright
© 2000 by The American Heart Association, Inc.
and
The American College of Cardiology
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