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

doi:10.1136/bmj.325.7375.1271

BMJ 2002;325:1271 ( 30 November )

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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

Francesco P Cappuccio, professor of primary care research and development, ^a Pippa Oakeshott, senior lecturer in general practice, ^a Pasquale Strazzullo, professor of medicine, ^b Sally M Kerry, senior lecturer in medical statistics. ^a

^a Department of General Practice and Primary Care, St George's Hospital Medical School, London SW17 0RE, ^b Department of Clinical and Experimental Medicine, Federico II Medical School, University of Naples, Italy I-80131

Correspondence to: F P Cappuccio f.cappuccio{at}sghms.ac.uk

Objective: To compare the 10 year risk of coronary heartdisease (CHD), stroke, and combined cardiovascular disease (CVD)estimated from the Framinghamequations.
Design: Population based cross sectionalsurvey.
Setting: Nine general practices in southLondon.
Population: 1386 men and women, age 40-59 years, withno history of CVD (475 white people, 447 south Asian people, and464 people of African origin), and a subgroup of 1069 withoutknown diabetes, left ventricular hypertrophy, peripheral vasculardisease, renal impairment, or target organdamage.
Main outcome measures: 10 year riskestimates.
Results: People of African origin had the lowest 10year 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 highestestimated 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 combinedCVD, 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 ofAfrican origin (10.5%, 9.7 to 11.2). In the subgroup of 1069,the probability that a risk of CHD $>=$ 15% would identify risk ofcombined CVD $>=$ 20% was 91% in white people and 81% in both southAsians and people of African origin. The use of thresholds forrisk of CHD of 12% in south Asians and 10% in people of Africanorigin would increase the probability of identifying those atrisk to 100% and 97%,respectively.
Conclusion: Primary care doctors should use a lower thresholdof CHD risk when treating mild uncomplicated hypertension in peopleof African or south Asianorigin.

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