Evaluating CMR
Assessing CVD Risk: Traditional Approaches
PROCAM
- 1Key Points (1 page)
- 2The PROCAM study (2 pages)
- 3The PROCAM risk algorithm (2 pages)
- 4Key findings of the PROCAM study (3 pages)
- 5References (1 page)
The PROCAM risk algorithm
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The PROCAM risk calculator is based on a scoring system for risk factors derived from 10 year follow-up data of the PROCAM study (7, 9, 10). The algorithm was initially developed and validated in the cohort of 5,389 men (35 to 65 years of age) recruited before the end of 1985. Among those participants, 325 developed major coronary events within 10 years. The risk algorithm was expressed as a simple scoring scheme in order to make it relevant to clinical practice. To construct the algorithm, a Cox proportional hazards model was used. The prediction model includes age, LDL cholesterol, HDL cholesterol, triglycerides, smoking, diagnosis of diabetes, family history of MI, and systolic blood pressure. In contrast to the previous model generated by the Framingham Heart Study, the PROCAM score used triglycerides and family history of premature MI to calculate the risk score. The categories for the continuous variables in the PROCAM score, such as age, blood pressure, LDL cholesterol, and HDL cholesterol, were based on the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) guidelines (11). However, in the case of triglycerides, the categories were based on the guidelines of the International Task Force for Prevention of CHD (12). Categorical variables are history of diabetes, history of MI, and smoking habits. A score is assigned to each level of the respective risk factor and the total score is calculated by adding up the points for each risk factor. The sum of these points provides the estimate of overall cardiovascular risk. For each total score, the corresponding absolute risk of MI or CHD death within the next 10 years is obtained (13). In the PROCAM algorithm, the “high risk” group had a 10 year coronary event risk greater than 20%, which corresponded to a PROCAM score of 53 and above. This definition of “high risk” of coronary event was reached through consensus by the Second Joint Task Force of European and other Societies on Coronary Prevention (14). The American NCEP-ATP III guidelines (11) state that patients with an absolute risk of CHD exceeding 20% within the next 10 years should be considered at “high risk.” These patients require attention from health professionals and aggressive management of their modifiable risk factors.
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