Are the Framingham and PROCAM coronary heart disease risk functions applicable to different European populations? The PRIME Study
Abstract
AIMS: To assess whether the Framingham and PROCAM risk functions were applicable to men in Belfast and France. METHODS AND RESULTS: We performed an external validation study within the PRIME (Prospective Epidemiological Study of Myocardial Infarction) cohort study. It comprised men recruited in Belfast (2399) and France (7359) who were aged 50 to 59 years, free of CHD at baseline (1991 to 1993) and followed over 5 years for CHD events (coronary death, myocardial infarction, angina pectoris). We compared the relative risks of CHD associated with the classic risk factors in PRIME with those in Framingham and PROCAM cohorts. We then compared the number of predicted and observed 5-year CHD events (calibration). Finally, we estimated the ability of the risk functions to separate high risk from low risk subjects (discrimination). The relative risk of CHD calculated for the various factors in the PRIME population were not statistically different from those published in the Framingham and PROCAM risk functions. The number of CHD events predicted by these risk functions however clearly overestimated those observed in Belfast and France. The two risk functions had a similar ability to separate high risk from low risk subjects in Belfast and France (c-statistic range: 0.61-0.68). CONCLUSION: The Framingham and PROCAM risk functions should not be used to estimate the absolute CHD risk of middle-aged men in Belfast and France without any CHD history because of a clear overestimation. Specific population risk functions are needed.
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Similar relative risks were obtained for the classic cardiovascular risk factors for men living in Northern Ireland, France, the USA and Germany, despite the fact that the underlying risk of coronary heart disease varies substantially between these countries.
“For example, similar relative risks were obtained for the classic cardiovascular risk factors for men living in Northern Ireland, France, the USA and Germany, despite the fact that the underlying risk of coronary heart disease varies substantially between these countries [ 166 , 167 ].”
From Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration (2007) · cites this paper as [166]
Relative effects or associations tend to be more consistent across studies and populations than absolute measures.
“Relative effects or associations tend to be more consistent across studies and populations than absolute measures, but what often tends to be the case may be irrelevant in a particular instance.”
From Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration (2007) · cites this paper as [166]
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- Authors
- Empana, J.
- Affiliations
- Inserm (FR)
- Corresponding author
- Empana, J
- ORCID
- Empana, J
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2003-11
- Volume
- 24
- Issue
- 21
- Pages
- 1903-1911
- ISSN
- 0195-668X (ISSN-L)
- OpenAlex
- W2087942162
- Cited by
- 263
- References
- 25
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 3 · 2023: 5 · 2022: 5 · 2021: 4 · 2020: 5 · 2019: 5 · 2018: 6 · 2017: 4 · 2016: 6 · 2015: 12 · 2014: 6 · 2013: 12 · 2012: 12
- FWCI
- 19.09
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Institut National de la Santé et de la Recherche Médicale
- Northern Ireland Chest Heart and Stroke
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Keywords
- coronary heart disease risk prediction, Framingham risk equation, external validation, PRIME study, middle-aged men, discrimination (statistics), Belfast, France
- MeSH terms
- Adult, Aged, Angina Pectoris, Coronary Disease, France, Humans, Male, Middle Aged, Myocardial Infarction, Northern Ireland, Predictive Value of Tests, Prognosis, Prospective Studies, Risk Factors, Sensitivity and Specificity, Cohort Studies, Proportional Hazards Models, Risk Assessment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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