Article

Numerous studies have examined the validity of available scores to
predict the absolute cardiovascular risk. We developed a virtual
population based on data representative of the French population and compared the
performances of the two most popular risk equations to predict cardiovascular
death: Framingham and SCORE. METHODS: A population was built based on official
French demographic statistics and summarized data from representative
observational studies. The 10-year coronary and cardiovascular death risk and
their ratio were computed for each individual by SCORE and Framingham equations.
The resulting rates were compared with those derived from national vital
statistics. RESULTS: Framingham overestimated French coronary deaths by 2.8 in
men and 1.9 in women, and cardiovascular deaths by 1.5 in men and 1.3 in women.
SCORE overestimated coronary death by 1.6 in men and 1.7 in women, and
underestimated cardiovascular death by 0.94 in men and 0.85 in women. Our results
revealed an exaggerated representation of coronary among cardiovascular death
predicted by Framingham, with coronary death exceeding cardiovascular death in
some individual profiles. Sensitivity analyses gave some insights to explain the
internal inconsistency of the Framingham equations. CONCLUSION: Evidence is that
SCORE should be preferred to Framingham to predict cardiovascular death risk in
French population. This discrepancy between prediction scores is likely to be
observed in other populations. To improve the validation of risk equations,
specific guidelines should be issued to harmonize the outcomes definition across
epidemiologic studies. Prediction models should be calibrated for risk
differences in the space and time dimensions.

Langue : ANGLAIS

Tiré à part : OUI