title: Does consideration of either psychological or material disadvantage improve coronary risk prediction? Prospective observational study of Scottish men.
abstract: OBJECTIVE
  To assess the value of psychosocial risk factors in discriminating between individuals at higher and lower risk of coronary heart disease, using risk prediction equations.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Scotland.
  
  
  METHODS
  5191 employed men aged 35 to 64 years and free of coronary heart disease at study enrollment
  
  
  METHODS
  Area under receiver operating characteristic (ROC) curves for risk prediction equations including different risk factors for coronary heart disease.
  
  
  RESULTS
  During the first 10 years of follow up, 203 men died of coronary heart disease and a further 200 were admitted to hospital with this diagnosis. Area under the ROC curve for the standard Framingham coronary risk factors was 74.5%. Addition of "vital exhaustion" and psychological stress led to areas under the ROC curve of 74.5% and 74.6%, respectively. Addition of current social class and lifetime social class to the standard Framingham equation gave areas under the ROC curve of 74.6% and 74.9%, respectively. In no case was there strong evidence for improved discrimination of the model containing the novel risk factor over the standard model.
  
  
  CONCLUSIONS
  Consideration of psychosocial risk factors, including those that are strong independent predictors of heart disease, does not substantially influence the ability of risk prediction tools to discriminate between individuals at higher and lower risk of coronary heart disease.
authors: Department of Primary Care and General Practice, Primary Care Clinical Sciences and Learning Centre Building, University of Birmingham, Edgbaston, Birmingham, UK. j.a.macleod@bham.ac.uk
authors: John
authors: J
authors: Macleod
authors: Chris
authors: C
authors: Metcalfe
authors: George Davey
authors: GD
authors: Smith
authors: Carole
authors: C
authors: Hart
mesh_terms: D000328:Adult; D003324:Coronary Artery Disease / Q000209:etiology* / Q000517:prevention & control; D005544:Forecasting; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011584:Psychology; D012372:ROC Curve; D018570:Risk Assessment / Q000706:statistics & numerical data; D012307:Risk Factors; D012606:Scotland; D012923:Social Class
references: Int J Epidemiol. 2003 Dec;32(6):990-7
references: 14681262
references: Heart. 2006 Oct;92(10):1396-401
references: 16547204
references: Circulation. 1991 Jan;83(1):356-62
references: 1984895
references: Ann Intern Med. 2006 Jul 4;145(1):21-9
references: 16818925
references: BMJ. 1999 Jun 26;318(7200):1725-9
references: 10381706
references: BMJ. 1997 Feb 22;314(7080):547-52
references: 9055712
references: BMJ. 1998 May 30;316(7145):1631-5
references: 9603744
references: BMJ. 2003 Nov 29;327(7426):1267
references: 14644971
references: BMJ. 2003 Nov 29;327(7426):1238-9
references: 14644935
references: Br J Health Psychol. 2001 May;6(Pt 2):167-78
references: 14596732
references: Am Heart J. 1990 Mar;119(3 Pt 2):712-7; discussion 717
references: 2137960
references: Monogr Ser World Health Organ. 1968;56:1-188
references: 4972212
references: Am Heart J. 1991 Jan;121(1 Pt 2):293-8
references: 1985385
references: Ann Intern Med. 1970 Jun;72(6):813-22
references: 4247338
references: Heart. 2006 Mar;92(3):307-10
references: 16166099
references: Br J Clin Psychol. 1992 Sep;31(3):351-6
references: 1393166
references: BMJ. 2002 May 25;324(7348):1247-51
references: 12028978
references: Int J Epidemiol. 2004 Apr;33(2):235-9
references: 15082618
references: BMJ. 1996 Dec 7;313(7070):1434-8
references: 8973230
references: BMJ. 1997 Jun 7;314(7095):1666-74
references: 9193292
references: Biometrics. 1991 Mar;47(1):281-8
references: 2049501
references: BMJ. 2006 Mar 4;332(7540):521-5
references: 16428252
references: Br J Gen Pract. 2005 Nov;55(520):838-45
references: 16281999
references: Br J Prev Soc Med. 1977 Mar;31(1):42-8
references: 856370
references: Lancet. 2003 Oct 11;362(9391):1225-30
references: 14568747
references: Health Bull (Edinb). 1993 Mar;51(2):72-9
references: 8514493
references: Lancet. 2004 Sep 11-17;364(9438):953-62
references: 15364186
references: Lancet. 2002 Jul 6;360(9326):2-3
references: 12114031