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Heart disease risk in British men is overestimated

Predictive accuracy of the Framingham coronary risk score in British men: prospective cohort study BMJ Volume 327, pp 1267-70. Editorial: Risk factor scoring for coronary heart disease BMJ Volume 327, pp 1238-9

Researchers assessed the accuracy of the Framingham risk equation for coronary heart disease in 6,643 British men aged 40-59 years. All men were initially free of heart disease.

Over a 10 year period, 2.8% of men died from coronary heart disease compared with 4.1% predicted – a overestimation of 47%. A fatal or non-fatal coronary heart disease event occurred in 10.2% of the men compared with 16% predicted – an overestimation of 57%.

The degree of over-prediction was similar at all risk levels, so that overestimation of absolute risk was greatest for people at highest risk. However, a simple adjustment by the authors improved the level of accuracy.

These finding have important implications, say the authors. For instance, an overestimated assessment of coronary heart disease risk will undermine a patient's ability to make an informed choice about starting preventive treatment, may cause unnecessary anxiety, and may affect life insurance premiums.

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