title: SCORE should be preferred to Framingham to predict cardiovascular death in French population.
abstract: BACKGROUND
  Numerous studies have examined the validity of available scores to predict the absolute cardiovascular risk.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: IMTh - Institute for Theoretical Medicine; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Service de Pharmacologie Clinique, Lyon, France. im@upcl.univ-lyon1.fr
authors.forename: Ivanny
authors.initials: I
authors.lastname: Marchant
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Boissel
authors.forename: Behrouz
authors.initials: B
authors.lastname: Kassaï
authors.forename: Theodora
authors.initials: T
authors.lastname: Bejan
authors.forename: Jacques
authors.initials: J
authors.lastname: Massol
authors.forename: Chrystelle
authors.initials: C
authors.lastname: Vidal
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Amsallem
authors.forename: Florence
authors.initials: F
authors.lastname: Naudin
authors.forename: Pilar
authors.initials: P
authors.lastname: Galan
authors.forename: Sébastien
authors.initials: S
authors.lastname: Czernichow
authors.forename: Patrice
authors.initials: P
authors.lastname: Nony
authors.forename: François
authors.initials: F
authors.lastname: Gueyffier
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D003198:Computer Simulation; D005260:Female; D005602:France / Q000453:epidemiology; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors