Evaluating CMR

Key findings of the PROCAM study

Multivariate analyses from the PROCAM study (17) also demonstrated that cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides showed a significant age-adjusted association with incidence of acute coronary events. Moreover, the association between triglycerides and CHD risk remained significant even after adjusting for LDL cholesterol, HDL cholesterol, and other traditional risk factors such as age, systolic blood pressure, cigarette smoking, type 2 diabetes, family history of MI, and angina pectoris.

In addition, an analysis of the incidence of coronary events (incidence per 1,000 in 8 years) revealed that the highest PROCAM score quintile had an over fortyfold increased risk of coronary events compared to the lowest quintile (20). These estimates were based on a multiple logistic function derived from multiple metabolic risk variables (age, LDL cholesterol, HDL cholesterol, systolic blood pressure, triglycerides, cigarette smoking, type 2 diabetes, and family history of MI).

Additional studies have also verified that the PROCAM score applies to other populations. Cooper et al. (21) compared the predictive value of the PROCAM and Framingham risk algorithms in healthy men from the United Kingdom recruited for the Second Northwick Park Heart Study (NPHS-II) and followed for a median of 10.8 years for CHD events. Interestingly, despite the fact that the PROCAM score was derived from a European population (Germany), this algorithm was marginally better than the Framingham score in predicting CHD in men from the United Kingdom. Moreover, both the PROCAM and Framingham scores tended to overestimate the rates of MI and sudden coronary death. Similarly, Empana et al. (22) assessed the applicability of PROCAM and Framingham risk functions to middle-aged men from Northern Ireland and France in the Prospective Epidemiological Study of Myocardial Infraction (étude PRospective de l’Infractus du MyocardE-PRIME) cohort.