Evaluating CMR
Assessing CVD Risk: Traditional Approaches
Limitations
- 1Key Points (1 page)
- 2Predicting CVD risk (1 page)
- 3Applicability of prediction models to different populations (2 pages)
- 4Limited risk prediction models in women (1 page)
- 5Exclusion of subjects with type 2 diabetes (2 pages)
- 6Exclusion of potential risk factors in prediction equations (1 page)
- 7Endpoints heterogeneity (1 page)
- 8References (1 page)
Applicability of prediction models to different populations
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Among the seminal studies that have enhanced understanding of cardiovascular risk factors, the Framingham Heart Study is the most renowned American prospective study focusing on cardiovascular endpoints (6). Although the key findings of this landmark prospective study are used to estimate CHD risk around the world, it should be noted that this study was conducted on a relatively homogeneous American population that was predominantly white middle-class living within a limited geographical area (the city of Framingham, Massachusetts). It is therefore likely that the Framingham risk score is better suited to a white population and less accurate for other ethnic groups. Moreover, it has been reported that the Framingham risk score overestimated CHD risk in Northern and Southern European populations (7-9). The Framingham risk score appears to apply to other populations with similar average levels of risk such as the United States (10) and Europe (11), but it clearly overestimates CHD risk in populations at lower risk. It is therefore important that additional cohort studies be performed in various ethnic groups and parts of the world to provide risk assessment tools that are relevant to other populations, particularly those at low average CHD risk. In addition, young individuals were underrepresented in the Framingham sample and had few CHD events. Because the Framingham 10-year risk score is heavily affected by age, the model may lack precision regarding the subpopulation of younger adults.
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