Comparison of population coronary heart disease risk estimated by the Framingham original and REGICOR calibrated functions

The therapeutic consequences of using the Framingham function calibrated by the REGICOR and Framingham investigators (Framingham-REGICOR) in the Spanish population are unknown. The objective of this study was to determine the differences in the classification of the population coronary risk when using the classical Framingham function (Framingham-Wilson) and that calibrated, and its consequences on the theoretical indication of lipid-lowering treatment. The classification into the < 2%, 2-4,9%, 5-9,9%, 10-19,9%, 20-39,9%, and >= 40% risk categories observed by the two functions was compared in 3.270 individuals aged 35 to 74 years with no history of ischaemic heart disease or lipid-lowering drug treatment, recruited in two population samples representative of Girona between 1994 and 2001. The number of lipid-lowering treatment candidates was estimated applying the most recent guidelines for clinical practice, according to the risk level obtained with both functions. The proportion of patients excluded owing to the fact that they already were on lipid-lowering treatment was 6.2%. The Framingham-REGICOR assigned 54.2% of women and 67.9% of men to a lower level of risk as compared to the Framingham-Wilson function. In 0.2% of women and 21.2% of men the decrease was two categories of risk. The figures in diabetic participants were 75.7 and 18.5%, respectively. When the European recommendations published in 2003 were applied, lipid-lowering treatment would have been indicated in 14.5% and in 4.4% of non-diabetic participants by the Framingham-Wilson and the Framingham-REGICOR, respectively. The calibrated Framingham-REGICOR function assigns a lower coronary risk category in more than 50% of women and almost 90% of men than the uncalibrated Framingham function. The calibrated function is more suitable for risk estimation in primary prevention than the original function in Spain.