Comparative accuracy of cardiovascular risk prediction methods in primary care patients.
OBJECTIVE
To compare the relative accuracy of cardiovascular disease risk prediction methods based on equations derived from the Framingham heart study.


METHODS
Risk factor data were collected prospectively from subjects being evaluated by their primary care physicians for prevention of cardiovascular disease. Projected cardiovascular risks were calculated for each patient with the Framingham equations, and also estimated from the risk tables and charts based on the same equations.


METHODS
12 primary care practices (46 doctors) in Birmingham.


METHODS
691 subjects aged 30-70 years.


METHODS
Sensitivity, specificity, and positive and negative predictive values of the Framingham based risk tables and charts for treatment thresholds based on projected cardiovascular disease or coronary heart disease risk.


RESULTS
59 subjects (8.5%) had projected 10 year coronary heart disease risks >/= 30%, and 291 (42.1%) had risks >/= 15%. At equivalent projected risk levels (10 year coronary heart disease >/= 30% and five year cardiovascular disease >/= 20%), the original Sheffield tables and those from New Zealand have the same sensitivities (40.0%, 95% confidence interval (CI) 26.6% to 57.8% v 41.2%, 95% CI 28.7% to 57. 3%) and specificities (98.6%, 95% CI 97.2% to 99.3% v 99.7%, 95% CI 98.8% to 100%). Modifications to the Sheffield tables improve sensitivity (91.4%, 95% CI 81.3% to 96.9%) but reduce specificity (95.8%, 95% CI 93.9% to 97.3%). The revised joint British recommendations' charts have high specificity (98.7%, 95% CI 97.5% to 99.5%) and good sensitivity (84.7%, 95% CI 71.0% to 93.0%).


CONCLUSIONS
The revised joint British recommendations charts appear to have the best combination of sensitivity and specificity for use in primary care patients.
Jones
A F
AF
Department of Clinical Biochemistry, Birmingham Heartlands and Solihull NHS Trust, Birmingham B9 5SS, UK. JonesAla@heartsol.wmids.nhs.uk
Walker
J
J
Jewkes
C
C
Game
F L
FL
Bartlett
W A
WA
Marshall
T
T
Bayly
G R
GR
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000379:methods*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012907:Smoking / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology