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Application of Framingham risk estimates to ethnic minorities in United Kingdom and implications for primary prevention of heart disease in general practice: cross sectional population based study

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7375.1271 (Published 30 November 2002) Cite this as: BMJ 2002;325:1271
  1. Francesco P Cappuccio, professor of primary care research and development (f.cappuccio{at}sghms.ac.uk)a,
  2. Pippa Oakeshott, senior lecturer in general practicea,
  3. Pasquale Strazzullo, professor of medicineb,
  4. Sally M Kerry, senior lecturer in medical statisticsa
  1. a Department of General Practice and Primary Care, St George's Hospital Medical School, London SW17 0RE,
  2. b Department of Clinical and Experimental Medicine, Federico II Medical School, University of Naples, Italy I-80131
  1. Correspondence to: F P Cappuccio
  • Accepted 2 September 2002

Abstract

Objective: To compare the 10 year risk of coronary heart disease (CHD), stroke, and combined cardiovascular disease (CVD) estimated from the Framingham equations.

Design:Population based cross sectional survey.

Setting: Nine general practices in south London.

Population: 1386 men and women, age 40-59 years, with no history of CVD (475 white people, 447 south Asian people, and 464 people of African origin), and a subgroup of 1069 without known diabetes, left ventricular hypertrophy, peripheral vascular disease, renal impairment, or target organ damage.

Main outcome measures: 10 year risk estimates.

Results: People of African origin had the lowest 10 year risk estimate of CHD adjusted for age and sex (7.0%, 95% confidence interval 6.5 to 7.5) compared with white people (8.8%, 8.2 to 9.5) and south Asians (9.2%, 8.6 to 9.9) and the highest estimated risk of stroke (1.7% (1.5 to 1.9), 1.4% (1.3 to 1.6), 1.6% (1.5 to 1.8), respectively). The estimate risk of combined CVD, however, was highest in south Asians (12.5%, 11.6 to 13.4) compared with white people (11.9%, 11.0 to 12.7) and people of African origin (10.5%, 9.7 to 11.2). In the subgroup of 1069, the probability that a risk of CHD 15% would identify risk of combined CVD 20% was 91% in white people and 81% in both south Asians and people of African origin. The use of thresholds for risk of CHD of 12% in south Asians and 10% in people of African origin would increase the probability of identifying those at risk to 100% and 97%, respectively.

Conclusion: Primary care doctors should use a lower threshold of CHD risk when treating mild uncomplicated hypertension in people of African or south Asian origin.

Footnotes

  • Funding Former Wandsworth Health Authority, South Thames Regional Health Authority, NHS research and development directorate, British Heart Foundation, British Diabetic Association, and Stroke Association.

  • Competing interests None declared.

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