title: Prediction of cardiovascular death in racial/ethnic minorities using Framingham risk factors.
abstract: BACKGROUND
  Risk factors for cardiovascular disease (CVD) derived from the Framingham study are widely used to guide preventive efforts. It remains unclear whether these risk factors predict CVD death in racial/ethnic minorities as well as they do in the predominately white Framingham cohorts.
  
  
  RESULTS
  Using linked data from the National Health and Nutrition Examination Survey III (1988 to 1994) and the National Death Index, we developed Cox proportional hazard models that predicted time to cardiovascular death separately for non-Hispanic white (NHW), non-Hispanic black (NHB), and Mexican American (MA) participants ages 40 to 80 years with no previous CVD. We compared calibration and discrimination for the 3 racial/ethnic models. We also plotted predicted 10-year CVD mortality by age for the three racial/ethnic groups while holding other risk factors constant (3437 NHW, 1854 NHB, and 1834 MA subjects met inclusion criteria). Goodness-of-fit chi(2) tests demonstrated adequate calibration for the 3 models (NHW, P=0.49; NHB, P=0.47; MA; P=0.55), and areas under the receiver operating characteristic curves demonstrated similar discrimination (c-statistics: NHW, 0.8126; NHB, 0.7679; and MA, 0.7854). Older age was more strongly associated with CVD mortality in NHWs (hazard ratio, 3.37; 95% CI, 2.80 to 4.05) than NHBs (hazard ratio, 2.29; 95% CI, 1.91 to 2.75) and was intermediate in MAs (hazard ratio, 2.46; 95% CI, 1.95 to 3.11). Predicted 10-year mortality rate was highest for NHBs across all age ranges and was higher for MAs than NHWs until late in the seventh decade.
  
  
  CONCLUSIONS
  Framingham risk factors predict CVD mortality equally well in NHWs, NHBs, and MAs, but the strength of the association between individual risk factors and CVD mortality differs by race and ethnicity. When other risk factors are held constant, minority individuals are at higher risk of CVD mortality at younger ages than NHWs.
authors.affiliation: Divisions of General Internal Medicine and Cardiology, Denver Health, Denver, CO 80204, USA. laura.hurley@dhha.org
authors.forename: Laura P
authors.initials: LP
authors.lastname: Hurley
authors.forename: L Miriam
authors.initials: LM
authors.lastname: Dickinson
authors.forename: Raymond O
authors.initials: RO
authors.lastname: Estacio
authors.forename: John F
authors.initials: JF
authors.lastname: Steiner
authors.forename: Edward P
authors.initials: EP
authors.lastname: Havranek
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000208:ethnology* / Q000209:etiology / Q000401:mortality*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D006306:Health Surveys; D006801:Humans; D053208:Kaplan-Meier Estimate; D017058:Mexican Americans / Q000706:statistics & numerical data; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data