Framingham – ATP (Adult Treatment Panel) III
| Background info: Framingham-ATP III |
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1) End-points measured
- 10 year risk of hard coronary heart disease (CHD)
- Hard CHD is defined to include:
- Myocardial infarction
- Coronary death
2) Profile of original population at baseline
- Framingham, USA
- Age: 30 to 79
- Baseline free of CHD, intermittent claudication, diabetes
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 |
|---|---|---|---|---|---|---|---|
| Aktas (1) | 2004 | US (Cleveland Clinic) | 50-75 | 8 years | 0.57 | SCORE was superior to Framingham | |
| Berry (2) | 2007 | US | 18-39 | 30 years | Neither method classified individuals under 30 as high risk despite substantial risk factor burden | ||
| Cook (3) | 2012 | US (women only) | 50-79 | 9.9 years (median) | Calibration plots used | 0.765 (Reynolds) | Reynolds Risk Score was better calibrated than the Framingham-based models. |
| 0.757 (Framingham ATP-III) | |||||||
| Cooper (4) | 2005 | UK (NPHS-II, men only) | 50-64 | 10 years | 2.13 | 0.62 | The algorithm based on NPHS-II data performs similarly to those for PROCAM and Framingham with respect to discrimination although no score had a high sensitivity. |
| D'Agostino (5) | 2001 | US (black, white, Japanese, Hispanic, native) | 5 | 0.63-0.83 | Sex-specific Framingham CHD prediction functions perform well among whites and blacks and can be applied to other ethnic groups after recalibration for differing prevalences of risk factors and underlying rates of CHD events. | ||
| Koller (6) | 2007 | Netherlands | >55 | >10 years | 1.38 | 0.63 (men), 0.73 (women) | Overestimate in <75 yrs men and underestimate in >75 yrs men and women |
| Marruqat (7) | 2003 | Spain | 10 years | 2.7 (men), 2.1 (women) | Estimates more than doubled the actual risk of coronary disease | ||
| Marrugat (8) | 2007 | Spain | 35-74 | 5 years | 0.68 (men), 0.73 (women) | Adapted Framingham-REGICOR predict more accurately |
Note:
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4) Length of follow up
- maximum of 12 years
5) Risk factors involved
- Non-modifiable risk factors
- Age
- Modifiable risk factors
- Total Cholesterol
- HDL
- Systolic blood pressure
- Treatment for hypertension
- Cigarette smoking
References
Primary publication:
Adult Treatment Panel III. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 3143-3421. http://circ.ahajournals.org/content/106/25/3143.full.pdf
1. Aktas MK, Ozduran V, Pothier CE, et al. Global risk scores and exercise testing for predicting all-cause mortality in a preventive medicine program. JAMA. 2004;292(12):1462-1468.
2. Berry JD, Lloyd-Jones DM, Garside DB, Greenland P. Framingham risk score and prediction of coronary heart disease death in young men. American Heart Journal. 2007;154(1):80-86.
3. Cook NR, Paynter NP, Eaton CB, et al. Comparison of the Framingham and Reynolds Risk Scores for global cardiovascular risk prediction in the multi-ethnic women’s health initiative. Circulation. 2012;125:1746-1756.
4. Cooper JA, Miller GJ, Humphries SE. A comparison of the PROCAM and Framingham point-scoring systems for estimation of individual risk of coronary heart disease in the Second Northwick Park Heart Study. Atherosclerosis. 2005;181(1):93-100.
5. D’Agostino RB, Sr., Grundy S, Sullivan LM, Wilson P, Group CHDRP. Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation. JAMA. 2001;286(2):180-187.
6. Koller MT, Steyerberg EW, Wolbers M, et al. Validity of the Framingham point scores in the elderly: results from the Rotterdam study. American Heart Journal. 2007;154(1):87-93.
7. Marrugat J, D’Agostino R, Sullivan L, et al. An adaptation of the Framingham coronary heart disease risk function to European Mediterranean areas. Journal of Epidemiology and Community Health. 01 Aug 2003;57(8):634-638.
8. 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.