This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Social Bookmarking   What's this?

Results of a Multiple Ethnic Groups Investigation

Ralph B. D'Agostino, Sr, PhD; Scott Grundy, MD,PhD; Lisa M. Sullivan, PhD; Peter Wilson, MD; for the CHD Risk Prediction Group

JAMA. 2001;286:180-187.

Context  The Framingham Heart Study produced sex-specific coronary heart disease (CHD) prediction functions for assessing risk of developing incident CHD in a white middle-class population. Concern exists regarding whether these functions can be generalized to other populations.

Objective  To test the validity and transportability of the Framingham CHD prediction functions per a National Heart, Lung, and Blood Institute workshop organized for this purpose.

Design, Setting, and Subjects  Sex-specific CHD functions were derived from Framingham data for prediction of coronary death and myocardial infarction. These functions were applied to 6 prospectively studied, ethnically diverse cohorts (n = 23 424), including whites, blacks, Native Americans, Japanese American men, and Hispanic men: the Atherosclerosis Risk in Communities Study (1987-1988), Physicians' Health Study (1982), Honolulu Heart Program (1980-1982), Puerto Rico Heart Health Program (1965-1968), Strong Heart Study (1989-1991), and Cardiovascular Health Study (1989-1990).

Main Outcome Measures  The performance, or ability to accurately predict CHD risk, of the Framingham functions compared with the performance of risk functions developed specifically from the individual cohorts' data. Comparisons included evaluation of the equality of relative risks for standard CHD risk factors, discrimination, and calibration.

Results  For white men and women and for black men and women the Framingham functions performed reasonably well for prediction of CHD events within 5 years of follow-up. Among Japanese American and Hispanic men and Native American women, the Framingham functions systematically overestimated the risk of 5-year CHD events. After recalibration, taking into account different prevalences of risk factors and underlying rates of developing CHD, the Framingham functions worked well in these populations.

Conclusions  The sex-specific Framingham CHD prediction functions perform well among whites and blacks in different settings and can be applied to other ethnic groups after recalibration for differing prevalences of risk factors and underlying rates of CHD events.

Author Affiliations: Departments of Mathematics and Statistics (Drs D'Agostino and Sullivan) and Medicine (Dr Wilson), Boston University, Boston, Mass; the Framingham Study, Framingham, Mass (Drs D'Agostino, Sullivan, and Wilson); and Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas (Dr Grundy).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

July 11, 2001
JAMA. 2001;286(2):243-244.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Adherence to Antihypertensive Medications and Cardiovascular Morbidity Among Newly Diagnosed Hypertensive Patients
Mazzaglia et al.
Circulation 2009;120:1598-1605.
ABSTRACT | FULL TEXT  

C-Reactive Protein as a Risk Factor for Coronary Heart Disease: A Systematic Review and Meta-analyses for the U.S. Preventive Services Task Force
Buckley et al.
ANN INTERN MED 2009;151:483-495.
ABSTRACT | FULL TEXT  

Emerging Risk Factors for Coronary Heart Disease: A Summary of Systematic Reviews Conducted for the U.S. Preventive Services Task Force
Helfand et al.
ANN INTERN MED 2009;151:496-507.
ABSTRACT | FULL TEXT  

Cardiovascular Disease Risk in a Semirural Community in Malaysia
Chia Yook Chin and Pengal
Asia Pac J Public Health 2009;21:410-420.
ABSTRACT  

The 6th Annual World Congress on the Insulin Resistance Syndrome
Bloomgarden
Diabetes Care 2009;32:e114-e121.
FULL TEXT  

Value and limitations of existing scores for the assessment of cardiovascular risk: a review for clinicians.
Cooney et al.
J Am Coll Cardiol 2009;54:1209-1227.
ABSTRACT | FULL TEXT  

ACCF/AHA 2009 performance measures for primary prevention of cardiovascular disease in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for Primary Prevention of Cardiovascular Disease) developed in collaboration with the American Academy of Family Physicians; American Association of Cardiovascular and Pulmonary Rehabilitation; and Preventive Cardiovascular Nurses Association Endorsed by the American College of Preventive Medicine, American College of Sports Medicine, and Society for Women's Health Research.
Redberg et al.
J Am Coll Cardiol 2009;54:1364-1405.
FULL TEXT  

ACCF/AHA 2009 Performance Measures for Primary Prevention of Cardiovascular Disease in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for Primary Prevention of Cardiovascular Disease): Developed in Collaboration With the American Academy of Family Physicians; American Association of Cardiovascular and Pulmonary Rehabilitation; and Preventive Cardiovascular Nurses Association: Endorsed by the American College of Preventive Medicine, American College of Sports Medicine, and Society for Women's Health Research
WRITING COMMITTEE MEMBERS et al.
Circulation 2009;120:1296-1336.
FULL TEXT  

Trends in 10-Year Predicted Risk of Cardiovascular Disease in the United States, 1976 to 2004
Lopez-Jimenez et al.
Circ Cardiovasc Qual Outcomes 2009;2:443-450.
ABSTRACT | FULL TEXT  

QRISK or Framingham for predicting cardiovascular risk?
Jackson et al.
BMJ 2009;339:b2673-b2673.
FULL TEXT  

Predicting the 30-Year Risk of Cardiovascular Disease: The Framingham Heart Study
Pencina et al.
Circulation 2009;119:3078-3084.
ABSTRACT | FULL TEXT  

Impact of Adding a Single Allele in the 9p21 Locus to Traditional Risk Factors on Reclassification of Coronary Heart Disease Risk and Implications for Lipid-Modifying Therapy in the Atherosclerosis Risk in Communities Study
Brautbar et al.
Circ Cardiovasc Genet 2009;2:279-285.
ABSTRACT | FULL TEXT  

Evaluating risk for cardiovascular diseases--vain or value? How do different cardiovascular risk scores act in real life
Ketola et al.
Eur J Public Health 2009;0:ckp070v1-ckp070.
ABSTRACT | FULL TEXT  

Prediction Model for Prevalence and Incidence of Advanced Age-Related Macular Degeneration Based on Genetic, Demographic, and Environmental Variables
Seddon et al.
IOVS 2009;50:2044-2053.
ABSTRACT | FULL TEXT  

Effectiveness of Valsartan for Treatment of Hypertension: Patient Profiling and Hierarchical Modeling of Determinants and Outcomes (the PREVIEW Study)
Van der Niepen et al.
The Annals of Pharmacotherapy 2009;43:849-861.
ABSTRACT | FULL TEXT  

Framingham Stroke Risk Function in a Large Population-Based Cohort of Elderly People: The 3C Study
Bineau et al.
Stroke 2009;40:1564-1570.
ABSTRACT | FULL TEXT  

Lifestyle Interventions Reduce Coronary Heart Disease Risk: Results From the PREMIER Trial
Maruthur et al.
Circulation 2009;119:2026-2031.
ABSTRACT | FULL TEXT  

Impact of Whole-Body CT Screening on the Cost-effectiveness of CT Colonography
Hassan et al.
Radiology 2009;251:156-165.
ABSTRACT | FULL TEXT  

Lipoprotein Particle Profiles by Nuclear Magnetic Resonance Compared With Standard Lipids and Apolipoproteins in Predicting Incident Cardiovascular Disease in Women
Mora et al.
Circulation 2009;119:931-939.
ABSTRACT | FULL TEXT  

Impact of Computer-aided Detection on the Cost-effectiveness of CT Colonography
Regge et al.
Radiology 2009;250:488-497.
ABSTRACT | FULL TEXT  

Utility of the Seattle heart failure model in patients with advanced heart failure.
Kalogeropoulos et al.
J Am Coll Cardiol 2009;53:334-342.
ABSTRACT | FULL TEXT  

Prevalence and Progression of Subclinical Atherosclerosis in Younger Adults With Low Short-Term but High Lifetime Estimated Risk For Cardiovascular Disease: The Coronary Artery Risk Development in Young Adults Study and Multi-Ethnic Study of Atherosclerosis
Berry et al.
Circulation 2009;119:382-389.
ABSTRACT | FULL TEXT  

Cardiovascular Disease Risk Prediction With and Without Knowledge of Genetic Variation at Chromosome 9p21.3
Paynter et al.
ANN INTERN MED 2009;150:65-72.
ABSTRACT | FULL TEXT  

Progressing From Risk Factors to Omics
Wilson
Circ Cardiovasc Genet 2008;1:141-146.
FULL TEXT  

Clinical Risk Factors, DNA Variants, and the Development of Type 2 Diabetes
Lyssenko et al.
NEJM 2008;359:2220-2232.
ABSTRACT | FULL TEXT  

Relation of N-terminal pro-brain natriuretic peptide levels and their prognostic power in chronic stable heart failure to obesity status
Frankenstein et al.
Eur Heart J 2008;29:2634-2640.
ABSTRACT | FULL TEXT  

C-Reactive Protein and Reclassification of Cardiovascular Risk in the Framingham Heart Study
Wilson et al.
Circ Cardiovasc Qual Outcomes 2008;1:92-97.
ABSTRACT | FULL TEXT  

Impact of High-Normal Blood Pressure on the Risk of Cardiovascular Disease in a Japanese Urban Cohort: The Suita Study
Kokubo et al.
Hypertension 2008;52:652-659.
ABSTRACT | FULL TEXT  

Hyponatremia and Mortality among Patients on the Liver-Transplant Waiting List
Kim et al.
NEJM 2008;359:1018-1026.
ABSTRACT | FULL TEXT  

Carotid Intima Media Thickness and Plaques Can Predict the Occurrence of Ischemic Cerebrovascular Events
Prati et al.
Stroke 2008;39:2470-2476.
ABSTRACT | FULL TEXT  

Marine-Derived n-3 Fatty Acids and Atherosclerosis in Japanese, Japanese-American, and White Men: A Cross-Sectional Study
Sekikawa et al.
J Am Coll Cardiol 2008;52:417-424.
ABSTRACT | FULL TEXT  

Cardiac Multidetector CT: Technical and Diagnostic Evaluation with Evidence-based Practice Techniques
Heffernan et al.
Radiology 2008;248:366-377.
ABSTRACT | FULL TEXT  

Ethnic Group Disparities in 10-Year Trends in Stroke Incidence and Vascular Risk Factors: The South London Stroke Register (SLSR)
Heuschmann et al.
Stroke 2008;39:2204-2210.
ABSTRACT | FULL TEXT  

Development and Validation of a Model for Predicting Emergency Admissions Over the Next Year (PEONY): A UK Historical Cohort Study
Donnan et al.
Arch Intern Med 2008;168:1416-1422.
ABSTRACT | FULL TEXT  

Ankle Brachial Index Combined With Framingham Risk Score to Predict Cardiovascular Events and Mortality: A Meta-analysis
Ankle Brachial Index Collaboration
JAMA 2008;300:197-208.
ABSTRACT | FULL TEXT  

Prediction of First Events of Coronary Heart Disease and Stroke With Consideration of Adiposity
Wilson et al.
Circulation 2008;118:124-130.
ABSTRACT | FULL TEXT  

Criteria for the Evaluation of Large Cohort Studies: An Application to the Nurses' Health Study
Colditz and Winn
JNCI J Natl Cancer Inst 2008;100:918-925.
ABSTRACT | FULL TEXT  

Global Coronary Heart Disease Risk Assessment of Individuals With the Metabolic Syndrome in the U.S.
Hoang et al.
Diabetes Care 2008;31:1405-1409.
ABSTRACT | FULL TEXT  

Beyond Established and Novel Risk Factors: Lifestyle Risk Factors for Cardiovascular Disease
Mozaffarian et al.
Circulation 2008;117:3031-3038.
FULL TEXT  

Evaluation of the Framingham Risk Score in the European Prospective Investigation of Cancer-Norfolk Cohort--Invited Commentary
Pencina and D'Agostino
Arch Intern Med 2008;168:1216-1218.
FULL TEXT  

Predicting values of lipids and white blood cell count for all-site cancer in type 2 diabetes
Yang et al.
Endocr Relat Cancer 2008;15:597-607.
ABSTRACT | FULL TEXT  

Coronary Calcium as a Predictor of Coronary Events in Four Racial or Ethnic Groups
Detrano et al.
NEJM 2008;358:1336-1345.
ABSTRACT | FULL TEXT  

Screening High-Risk Patients With Computed Tomography Angiography
Gottlieb and Lima
Circulation 2008;117:1318-1332.
FULL TEXT  

Development and Validation of an All-Cause Mortality Risk Score in Type 2 Diabetes: The Hong Kong Diabetes Registry
Yang et al.
Arch Intern Med 2008;168:451-457.
ABSTRACT | FULL TEXT  

Using Clinical Factors and Mammographic Breast Density to Estimate Breast Cancer Risk: Development and Validation of a New Predictive Model
Tice et al.
ANN INTERN MED 2008;148:337-347.
ABSTRACT | FULL TEXT  

General Cardiovascular Risk Profile for Use in Primary Care: The Framingham Heart Study
D'Agostino et al.
Circulation 2008;117:743-753.
ABSTRACT | FULL TEXT  

Impact of Impaired Fasting Glucose on Cardiovascular Disease: The Framingham Heart Study
Levitzky et al.
J Am Coll Cardiol 2008;51:264-270.
ABSTRACT | FULL TEXT  

A Risk Score for Predicting Near-Term Incidence of Hypertension: The Framingham Heart Study
Parikh et al.
ANN INTERN MED 2008;148:102-110.
ABSTRACT | FULL TEXT  

Development and Validation of a Prognostic Index for Health Outcomes in Chronic Obstructive Pulmonary Disease
Briggs et al.
Arch Intern Med 2008;168:71-79.
ABSTRACT | FULL TEXT  

Cardiovascular risk prediction: are we there yet?
Jackson
Heart 2008;94:1-3.
FULL TEXT  

Differences in Cardiovascular Disease Mortality Associated With Body Mass Between Black and White Persons
Abell et al.
AJPH 2008;98:63-66.
ABSTRACT | FULL TEXT  

Coronary Heart Disease Risk Assessment by Traditional Risk Factors and Newer Subclinical Disease Imaging: Is a "One-Size-Fits-All" Approach the Best Option?
Preis and O'Donnell
Arch Intern Med 2007;167:2399-2401.
FULL TEXT  

Projecting Individualized Absolute Invasive Breast Cancer Risk in African American Women
Gail et al.
JNCI J Natl Cancer Inst 2007;99:1782-1792.
ABSTRACT | FULL TEXT  

A coronary heart disease risk model for predicting the effect of potent antiretroviral therapy in HIV-1 infected men
May et al.
Int J Epidemiol 2007;36:1309-1318.
ABSTRACT | FULL TEXT  

External Prognostic Validations and Comparisons of Age- and Gender-Adjusted Exercise Capacity Predictions
Kim et al.
J Am Coll Cardiol 2007;50:1867-1875.
ABSTRACT | FULL TEXT  

Adherence with advice and prescriptions in SLE is mostly good, but better follow up is needed: A study with a questionnaire
Nived et al.
Lupus 2007;16:701-706.
ABSTRACT  

Reduction in Estimated Risk for Coronary Artery Disease After Use of Ezetimibe with a Statin
Sampalis et al.
The Annals of Pharmacotherapy 2007;41:1345-1351.
ABSTRACT | FULL TEXT  

The Framingham Predictive Instrument in Chronic Kidney Disease
Weiner et al.
J Am Coll Cardiol 2007;50:217-224.
ABSTRACT | FULL TEXT  

Cross-Classification of Microalbuminuria and Reduced Glomerular Filtration Rate: Associations Between Cardiovascular Disease Risk Factors and Clinical Outcomes
Foster et al.
Arch Intern Med 2007;167:1386-1392.
ABSTRACT | FULL TEXT  

2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)
Authors/Task Force Members: et al.
Eur Heart J 2007;0:ehm236v1-75.
FULL TEXT  

Screening for cardiovascular risk factors in a dental setting
Greenberg et al.
Journal of the American Dental Association 2007;138:798-804.
ABSTRACT | FULL TEXT  

Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: full text: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD)
Authors/Task Force Members et al.
Eur Heart J Suppl 2007;9:C3-C74.
FULL TEXT  

Osteopenia
Khosla and Melton
NEJM 2007;356:2293-2300.
FULL TEXT  

Prediction of Incident Diabetes Mellitus in Middle-aged Adults: The Framingham Offspring Study
Wilson et al.
Arch Intern Med 2007;167:1068-1074.
ABSTRACT | FULL TEXT  

Long-Term Prognosis Associated With Coronary Calcification: Observations From a Registry of 25,253 Patients
Budoff et al.
J Am Coll Cardiol 2007;49:1860-1870.
ABSTRACT | FULL TEXT  

Risk Factors, Risk Prediction, and the Apolipoprotein B-Apolipoprotein A-I Ratio
Berkwits and Guallar
ANN INTERN MED 2007;146:677-679.
FULL TEXT  

Framingham, SCORE, and DECODE Risk Equations Do Not Provide Reliable Cardiovascular Risk Estimates in Type 2 Diabetes
Coleman et al.
Diabetes Care 2007;30:1292-1293.
FULL TEXT  

Association of CFH Y402H and LOC387715 A69S With Progression of Age-Related Macular Degeneration
Seddon et al.
JAMA 2007;297:1793-1800.
ABSTRACT | FULL TEXT  

Biomarkers for Prediction of Cardiovascular Events
Musunuru et al.
NEJM 2007;356:1472-1475.
FULL TEXT  

The joint associations of occupational, commuting, and leisure-time physical activity, and the Framingham risk score on the 10-year risk of coronary heart disease
Hu et al.
Eur Heart J 2007;28:492-498.
ABSTRACT | FULL TEXT  

Cardiovascular risk prediction tools for populations in Asia
Asia Pacific Cohort Studies Collaboration
J. Epidemiol. Community Health 2007;61:115-121.
ABSTRACT | FULL TEXT  

ACCF/AHA 2007 Clinical Expert Consensus Document on Coronary Artery Calcium Scoring By Computed Tomography in Global Cardiovascular Risk Assessment and in Evaluation of Patients With Chest Pain: A Report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) Developed in Collaboration With the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography
Greenland et al.
J Am Coll Cardiol 2007;49:378-402.
FULL TEXT  

Effects of a Mediterranean-Style Diet on Cardiovascular Risk Factors
Martinez-Gonzalez et al.
ANN INTERN MED 2007;146:73-74.
FULL TEXT  

Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD)
Authors/Task Force Members et al.
Eur Heart J 2007;28:88-136.
FULL TEXT  

Validity of an adaptation of the Framingham cardiovascular risk function: the VERIFICA study
Marrugat et al.
J. Epidemiol. Community Health 2007;61:40-47.
ABSTRACT | FULL TEXT  

Risk Factors for Mortality in Middle-aged Women
Tice et al.
Arch Intern Med 2006;166:2469-2477.
ABSTRACT | FULL TEXT  

Accuracy and impact of risk assessment in the primary prevention of cardiovascular disease: a systematic review
Brindle et al.
Heart 2006;92:1752-1759.
ABSTRACT | FULL TEXT  

Estimation of 10-Year Risk of Fatal and Nonfatal Ischemic Cardiovascular Diseases in Chinese Adults
Wu et al.
Circulation 2006;114:2217-2225.
ABSTRACT | FULL TEXT  

Primary prevention of cardiovascular disease: a web-based risk score for seven British black and minority ethnic groups
Brindle et al.
Heart 2006;92:1595-1602.
ABSTRACT | FULL TEXT  

High Prevalence of Stroke Symptoms Among Persons Without a Diagnosis of Stroke or Transient Ischemic Attack in a General Population: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study.
Howard et al.
Arch Intern Med 2006;166:1952-1958.
ABSTRACT | FULL TEXT  

Cardiovascular disease risk factors in chronic kidney disease: overall burden and rates of treatment and control.
Parikh et al.
Arch Intern Med 2006;166:1884-1891.
ABSTRACT | FULL TEXT  

Has the Risk for Coronary Heart Disease Changed Among U.S. Adults?
Ajani and Ford
J Am Coll Cardiol 2006;48:1177-1182.
ABSTRACT | FULL TEXT  

Race and Ethnicity in Medical Research: Requirements Meet Reality
Winker
J Law Med Ethics 2006;34:520-525.
 

Efficacy and Safety in Clinical Trials in Cardiovascular Disease
Cohn
J Am Coll Cardiol 2006;48:430-433.
ABSTRACT | FULL TEXT  

Deficiencies of Cardiovascular Risk Prediction Models for Type 1 Diabetes
Zgibor et al.
Diabetes Care 2006;29:1860-1865.
ABSTRACT | FULL TEXT  

A 39-year-old woman with hypercholesterolemia.
Mittleman
JAMA 2006;296:319-326.
ABSTRACT | FULL TEXT