(Circulation. 2001;104:491.)
© 2001 American Heart Association, Inc.
Current Perspectives |
Cardiovascular Risk Assessment Based on US Cohort Studies
Findings From a National Heart, Lung, and Blood Institute Workshop
From the Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas (S.M.G.); Framingham Heart Study, Boston University, Boston, Mass (R.B.D., P.W.F.W.); Preventive Cardiology, Columbia and Cornell Universities, New York, NY (L.M.); Wake Forest School of Medicine, Winston-Salem, NC (G.B.); Preventive Cardiology and Lipid Research Center, University of Pennsylvania Health System, Philadelphia (D.R.); and Office of Prevention, Education, and Control (J.I.C., E.R.), Division of Epidemiology and Clinical Applications (J.C.), and Office of the Director (L.F.), National Heart, Lung, and Blood Institute, Bethesda, Md.
Correspondence to Jeffrey A. Cutler, MD, National Heart, Lung, and Blood Institute, 6701 Rockledge Dr, Bethesda, MD 20892-7936. E-mail cutlerj@nhlbi.nih.gov
Key Words: cardiovascular diseases • coronary disease • risk factors • epidemiology
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Introduction |
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This report was derived from a workshop on cardiovascular risk assessment sponsored by the National Heart, Lung, and Blood Institute, which addressed whether risk equations developed in the Framingham Heart Study (FHS) for predicting new-onset coronary heart disease (CHD) apply to diverse population groups. Preparation for the workshop included a reanalysis and comparison of prospective studies in several different populations in which risk factors were related to cardiovascular outcomes. Some studies included fatal and nonfatal CHD end points, whereas others contained only CHD mortality. Extensive collaboration provided as much uniformity as possible with respect to both risk factors and CHD end points.
The FHS has led in defining the quantitative impact of risk factors.1 Many potential risk factors were measured and related to cardiovascular outcomes. Several risk factors proved to be strong, largely independent predictors of cardiovascular disease (CVD). These factors—advancing age, cigarette smoking, blood pressure (particularly systolic), cholesterol in total serum and HDL, and diabetes—served as the basis for the development of risk prediction equations.1
If FHS risk estimates are to be widely used, they must apply widely in the US population. To document their transportability, they must be compared with prospective studies in other populations. Although the FHS is the longest running prospective study, there are other major studies. The cardiovascular end points of these other studies have varied. Some include cardiovascular morbidity and mortality; others have only cardiovascular mortality. Among the end points, CHD is the most extensively reported; for this reason, CHD was the primary focus
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