Framingham – REGICOR

Background info: Framingham-REGICOR

Framingham-REGICOR is not a scale produced by the Framingham Heart Study investigators but an example of a relatively well-studied calibrated Framingham-ATPIII scale to the Spanish population.

Framingham-ATPIII was chosen rather than Framingham-Wilson, at first, because the data from the REGICOR registry only contains information for “hard CHD” (1).

In a second publication by the same author, the same registry data was used for calibration of Framingham-Wilson, using an approximated “total CHD”, assuming that the proportion of “total” to “hard” CHD in the registry is the same as that of Framingham (2).

1) End-points measured

10 year risk of “hard” CHD

2) Profile of original population at baseline

Gerona, Spain
Age: 25-74
Baseline free of prevalent CHD
Participant number: 1480 (709 men, 771 women)
Population selected from: REGICOR population registry

3) Validation (the following prospective studies excludes cohort with history of CVD and diabetes at baseline)

Author	Year	Ethnicity	Age group	Follow up	Calibration ^	Discrimination ^^	Conclusion
Buitrago (3)	2006	Spainish	40-65	10 years	0.62 (calculated)		SCORE obtains better validity
Buitrago (4)	2011	Spanish	35-74	10 years	1.64	0.69	Under-predict risk by 64%
Comin (5)	2007	Spanish	35-74	5 years		positive predictive value	REGICOR gives the best balance of sensitivity and specificity
Marrugat (6)	2007	Spanish	35-74	5 years		0.69 (men), 0.81 (women)	Predicted accurately and reliably compared to original (Framingham-ATPIII) which overestimates.
Marrugat (7)	2011	Spanish	35-74	7.1 years(mean)	Hosmer and Lemeshow goodness-of-fit test for each decile risk group performed	0.78 (men), 0.82 (women)	The function accurately predicts coronary disease events at 10 years
Marrugat (8)	2014	Spanish	35-74	9.3 years (mean)		C-statistic 73.1 (men), 78.1 (women)	Framingham-REGICOR overestimate risk

Note:

Calibration is represented by the ratio of predicted value over observed value (e.g. a value closer to 1 indicates perfect calibration): for more information, please refer to Key Terms and Definitions

Discrimination is represented by the area under receiver operating curve (e.g. a value closer to 1 indicates better discrimination): for more information, please refer to Key Terms and Definitions

Area left blank means the information is either unavailable in the paper or the full paper is not accessible to the authors of this Wiki.

4) Length of follow up

10 years

5) Risk factors involved

Non-modifiable risk factors
- Age
Modifiable risk factors
- Diabetes
- Smoking
- JNC-V blood pressure categories (JNC: Joint National Committee)
- NCEP total cholesterol categories (NCEP: National Cholesterol Education Programme)
- LDL cholesterol categoriess Framingham-Wilson

6) Limitations

The incidence in Girona, Spain (where the REGICOR registry is conducted) has a acute myocardial infarction incidence 15% below the Spanish average (2).

References

Primary publication:

1. Marrugat J, D’Agostino R, Sullivan L, Elosua R, Wilson P, Ordovas J, et al. An adaptation of the Framingham coronary risk function to southern Europe Mediterranean areas. J Epidemiol Comm Health 2003; 57: 634-638 http://jech.bmj.com/content/57/8/634.full.pdf

2. Marrugat J, Solanas P, D’Agostino R, et al. Coronary risk estimation in Spain using a calibrated Framingham function. Rev Esp Cardiol. 2003;56(3):253-261. http://www.revespcardiol.org/sites/default/files/elsevier/pdf/255/255v56n03a13048453pdf001.pdf

3. Buitrago Ramirez F, Canon Barroso L, Diaz Herrera N, Cruces Muro E, Bravo Simon B, Perez Sanchez I. Comparison of the SCORE function chart and the Framingham-REGICOR equation to estimate the cardiovascular risk in an urban population after 10 years of follow-up. Medicina Clinica. 2006;127(10):368-373.

4. Buitrago F, Calvo-Hueros JI, Canon-Barroso L, et al. Original and REGICOR Framingham functions in a nondiabetic population of a Spanish health care center: a validation study. Annals of Family Medicine. 2011;9(5):431-438.

5. Comin E, Solanas P, Cabezas C, et al. Estimating cardiovascular risk in Spain using different algorithms. Revista Espanola de Cardiologia. 2007;60(7):693-702.

6. Marrugat J, Subirana I, Comin E, et al. Validity of an adaptation of the Framingham cardiovascular risk function: the VERIFICA Study. Journal of Epidemiology & Community Health. 2007;61(1):40-47.

7. Marrugat J, Vila J, Baena-Diez JM, et al. Relative validity of the 10-year cardiovascular risk estimate in a population cohort of the REGICOR study. Revista Española de Cardiología. 2011;64(5):385-394.

8. Marrugat J, Subirana I, Ramos R, et al. Derivation and validation of a set of 10-year cardiovascular risk predictive functions in Spain: The FRESCO Study. Preventive Medicine. 2014;61:66-74.

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