Evaluating CMR

The PROCAM study

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Over the last three decades, significant progress has been made in the identification of cardiovascular disease (CVD) risk factors. Identifying subjects at high risk of CVD is a key first step for CVD prevention (1). Data from large prospective studies (2-5) has facilitated the identification of major cardiovascular CVD risk factors such as age, gender, smoking, high blood pressure, elevated total and LDL cholesterol levels, and low HDL cholesterol concentrations. The fact that risk factors work in conjunction to elevate CVD risk has been recognized for decades, but high-risk individuals have largely been identified based on single risk factors. Many groups and organizations have worked to develop approaches to identify high-risk individuals using global risk algorithms. The Framingham Heart Study (6), a landmark American prospective cardiovascular study, has provided a wealth of information on major coronary heart disease (CHD) risk factors and paved the way to development of a simple CHD prediction algorithm by evaluating the presence and/or severity of several traditional risk factors. Another important study of cardiovascular epidemiology, the PROspective CArdiovascular Münster study (PROCAM) (7), has analyzed data from more than 20,000 subjects in Germany followed for over 25 years and developed a scoring system for predicting global CHD risk. In contrast to the Framingham Heart Study, which was conducted in a relatively homogenous American population within a limited geographical area (the city of Framingham, Massachusetts), the PROCAM study developed a risk calculator tailored to a Northern European population.

Reference

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1. Giampaoli S, Palmieri L, Mattiello A, et al. Definition of high risk individuals to optimise strategies for primary prevention of cardiovascular diseases. Nutr Metab Cardiovasc Dis 2005; 15: 79-85.

2. Greenland P, Knoll MD, Stamler J, et al. Major risk factors as antecedents of fatal and nonfatal coronary heart disease events. JAMA 2003; 290: 891-7.

3. Khot UN, Khot MB, Bajzer CT, et al. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA 2003; 290: 898-904.

4. Kannel WB, Dawber TR, Friedman GD, et al. Risk Factors in Coronary Heart Disease. An Evaluation of Several Serum Lipids as Predictors of Coronary Heart Disease; the Framingham Study. Ann Intern Med 1964; 61: 888-99.

5. Wilson PW. Established risk factors and coronary artery disease: the Framingham Study. Am J Hypertens 1994; 7: 7S-12S.

6. Wilson PW, D'Agostino RB, Levy D, et al. Prediction of coronary heart disease using risk factor categories. Circulation 1998; 97: 1837-47.

7. Assmann G, Cullen P and Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Munster (PROCAM) study. Circulation 2002; 105: 310-5.

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