title: Mapping the expanded often inappropriate use of the Framingham Risk Score in the medical literature.
abstract: OBJECTIVE
  To systematically evaluate the use of Framingham Risk Score (FRS) in the medical literature and specifically examine the use of FRS in different populations and settings and for different outcomes than the ones originally developed for.
  
  
  METHODS
  We identified all the citations to the article by Wilson et al. (1998), in which FRS was originally described through ISI Web of Science until April 2011. We selected studies that stated in their abstract that they calculated or used the FRS for any reason and extracted information on publication date, population studied, outcome, or disease risk factor with which FRS was associated and study design.
  
  
  RESULTS
  We identified 375 eligible articles corresponding to 471 analyses using the FRS in cohort (n = 141), case-control (n = 16), or cross-sectional (n = 314) settings. Only a minority of the cohort studies had as a primary aim to externally validate the FRS (n = 45). The studied population was different (from general or healthy) in 35 (25%) and 133 (42%) of the cohort and cross-sectional analyses, respectively. All case-control studies examined healthy controls. The studied outcome was different (from coronary heart disease) in 79 (56%) of the cohort analyses and 10 (63%) of the case-control studies. Overall, only 46 (33%) of the 141 cohort analyses examined the same outcome and population as FRS was originally developed for.
  
  
  CONCLUSIONS
  A large number of studies use FRS in populations and for outcomes other than the ones it has been developed for and therefore for which its performance is unknown and nonvalidated.
authors: Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, 45110 Ioannina, Greece; Department of Epidemiology and Biostatistics, Imperial College London, Norfolk Place W2 1PG, London, UK.
authors: Ioanna
authors: I
authors: Tzoulaki
authors: Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, 45110 Ioannina, Greece.
authors: Aristeidis
authors: A
authors: Seretis
authors: Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, 45110 Ioannina, Greece.
authors: Evangelia E
authors: EE
authors: Ntzani
authors: Department of Medicine, Stanford Prevention Research Center, 291 Campus Drive, Stanford, CA, 94305-5101 USA; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA; Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, USA. Electronic address: jioannid@stanford.edu.
authors: John P A
authors: JP
authors: Ioannidis
mesh_terms: D016022:Case-Control Studies; D015331:Cohort Studies; D003430:Cross-Sectional Studies / Q000379:methods*; D006801:Humans; D012107:Research Design / Q000592:standards*; D018570:Risk Assessment
keywords: Cardiovascular disease; Empirical study; Framingham risk score; Prediction models; Prognosis; Validation