title: Recalibration of a Framingham risk equation for a rural population in India.
abstract: BACKGROUND
  Coronary heart disease (CHD) risk estimation tools are a simple means of identifying those at high risk in a community and hence a potentially cost-effective strategy for CHD prevention in resource-poor countries. Since India has few local data upon which to develop such a tool de novo, in this study a Framingham risk equation has been recalibrated to estimate CHD risks in a population from rural India and the sensitivity of the method to information resources examined. Recent surveys of this population have found high levels of cardiovascular risk factors, particularly metabolic risk factors and a high proportion of mortality due to cardiovascular diseases.
  
  
  METHODS
  The proportion of a rural Indian population at high risk of CHD using three risk estimation equations was estimated. The first a published version of the Framingham risk equation, the second a recalibrated equation using local mortality surveillance data and local risk factor data, and the third a recalibrated equation using national mortality data and local risk factor data.
  
  
  RESULTS
  The mean 10-year probability of CHD for adults >30 years was 10.4% (9.6% to 11.1%) for men and 5.3% (4.9% to 5.7%) for women using the Framingham equation; 10.7% (9.9% to 11.5%) for men and 4.2% (3.9% to 4.5%) for women using the local recalibration; and 18.9% (17.7% to 20.1%) for men and 8.2% (7.6% to 8.8%) for women using the national recalibration.
  
  
  CONCLUSIONS
  These findings indicate that in India, equations recalibrated to summary national data are unlikely to be relevant to all regions of India and demonstrate the importance of local data collection to enable development of relevant CHD risk tools.
authors.affiliation: Population Health Research Institute, Hamilton General Hospital, Hamilton, Ontario, Canada. cchow@george.org.au
authors.forename: C K
authors.initials: CK
authors.lastname: Chow
authors.forename: R
authors.initials: R
authors.lastname: Joshi
authors.forename: D S
authors.initials: DS
authors.lastname: Celermajer
authors.forename: A
authors.initials: A
authors.lastname: Patel
authors.forename: B C
authors.initials: BC
authors.lastname: Neal
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012423:Rural Health / Q000706:statistics & numerical data; D017678:Sex Distribution; D012737:Sex Factors