Vrentzos G E, Papadakis J A, Ganotakis E S, Paraskevas K I, Gazi I F, Tzanakis N, Nair D R, Mikhailidis D P
Department of Clinical Biochemistry, Vascular Disease Prevention Clinic, Royal Free Hospital and Royal Free University College Medical School, London, UK.
Int J Clin Pract. 2007 Oct;61(10):1643-53. doi: 10.1111/j.1742-1241.2007.01527.x.
To compare the Framingham and Prospective Cardiovascular Munster (PROCAM) risk calculations.
We calculated the risk in 234 dyslipidaemic patients without overt vascular disease and in different subgroups. For example, the proportion of patients with coronary heart disease (CHD) risk >or= 20%, the effect of including the family history (FaHist) and of adjusting raised triglyceride (TG) levels.
The Framingham risk was significantly (p < 0.0001) higher than the PROCAM risk (with and without including the FaHist) in different subgroups and when the TGs were adjusted to 1.7 mmol/l. The percentage of patients with CHD risk >or= 20% calculated by the Framingham (based on systolic or diastolic blood pressure) and PROCAM equations was 21.4% or 23.1% and 16.2% respectively. In the tertile with the highest PROCAM risk, the Framingham score was significantly greater than the PROCAM risk only when the FaHist was included in the Framingham calculation. When we analysed risk by gender, the Framingham score did not differ but the PROCAM risk was significantly (p < 0.0001) greater in men. When TG values were adjusted to 1.7 mmol/l, the predicted risk using PROCAM changed by 0% to -2% in all subgroups.
In dyslipidaemic patients without overt vascular disease the Framingham model predicted a higher risk than PROCAM. Thus, the Framingham equation probably leads to substantial overtreatment compared with PROCAM. However, according to the literature, even the PROCAM equation may overestimate risk. This has considerable cost implications. New more accurate risk engines are needed to calculate risk in dyslipidaemic patients without overt vascular disease.
比较弗明汉和明斯特前瞻性心血管病（PROCAM）风险计算方法。
我们计算了234例无明显血管疾病的血脂异常患者及不同亚组的风险。例如，冠心病（CHD）风险≥20%的患者比例、纳入家族史（FaHist）的影响以及调整升高的甘油三酯（TG）水平的影响。
在不同亚组中，以及将TG调整至1.7 mmol/l时，弗明汉风险显著高于PROCAM风险（无论是否纳入FaHist，p<0.0001）。根据弗明汉（基于收缩压或舒张压）和PROCAM方程计算，CHD风险≥20%的患者百分比分别为21.4%或23.1%和16.2%。在PROCAM风险最高的三分位数中，仅当弗明汉计算中纳入FaHist时，弗明汉评分才显著高于PROCAM风险。当我们按性别分析风险时，弗明汉评分无差异，但男性的PROCAM风险显著更高（p<0.0001）。当TG值调整至1.7 mmol/l时，所有亚组中使用PROCAM预测的风险变化为0%至 -2%。
在无明显血管疾病的血脂异常患者中，弗明汉模型预测的风险高于PROCAM。因此，与PROCAM相比，弗明汉方程可能导致大量过度治疗。然而，根据文献，即使PROCAM方程也可能高估风险。这具有相当大的成本影响。需要新的更准确的风险评估工具来计算无明显血管疾病的血脂异常患者的风险。
