Value and Limitations of Existing Scores for the Assessment of Cardiovascular RiskA Review for Clinicians
Marie Therese Cooney, MB, BCh, BAO,
Alexandra L. Dudina, MB and
Ian M. Graham, MB, BCh, BAO, BA*
Adelaide Meath Hospital, Tallaght, Dublin, Ireland
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Figure 1 CHD Mortality Rates in Men <65 Years Old
Global age-standardized coronary heart disease (CHD) mortality rates in men under age 65 years (1950 to 2006). Figure drawn using World Health Organization statistics (13). Dark blue line indicates Finland; red line, France; green line, Hungary; purple line, Japan; dark red line, Ukraine; orange line, United Kingdom; light blue line, U.S.
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Figure 2 Observed to Predicted Risk
Observed to predicted risk demonstrated in external validation studies of Framingham. Reprinted from Brindle et al. (45). CHD = coronary heart disease; CI = confidence interval; CVD = cardiovascular disease; RR = relative risk; WOSCOPS = West of Scotland Coronary Prevention Study.
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Figure 4 Formats for Some Current Risk Estimation Systems
(A) Interface for ASSIGN SCORE online calculator. (B) New Zealand risk chart (Framingham adaptation), reprinted with permission from the New Zealand Guidelines Group (18). (C) Portable Framingham risk calculator. (D) Joint British guidelines risk chart (Framingham adaptation), reprinted with permission from the British Cardiac Society et al. (48). (E) Sample WHO/ISH risk chart. (F) Interface for QRISK2 online calculator. (G) PROCAM scoring sheet. CHD = coronary heart disease; CVD = cardiovascular disease; HDL = high-density lipoprotein; LDL = low-density lipoprotein; SBP = systolic blood pressure; TC = total cholesterol; TIA = transient ischemic attack.
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Figure 5 Improved Calibration of Framingham Function in Chinese Cohort After Recalibration
Calibration, predicted event rates (open bars) compared with actual coronary heart disease (CHD) event rates (solid bars), based on (A) the original Framingham function and (B) the recalibrated Framingham function in the CMCS (Chinese Multi-Provincial Cohort Study). Reprinted from Liu et al. (58).
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Figure 6 Relative Risk Chart
This chart may be useful in explaining to a younger person that, even if his or her absolute risk is low, it may still be 10 to 12 times higher than that of a person of a similar age with low risk factors.
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