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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

By Francesco Cappuccio, Pippa Oakeshott, Pasquale Strazzullo and Sally M. Kerry


Objective To compare the 10 year risk of coronary\ud heart disease (CHD), stroke, and combined\ud cardiovascular disease (CVD) estimated from the\ud Framingham equations.\ud Design Population based cross sectional survey.\ud Setting Nine general practices in south London.\ud Population 1386 men and women, age 40­59 years,\ud with no history of CVD (475 white people, 447 south\ud Asian people, and 464 people of African origin), and\ud a subgroup of 1069 without known diabetes, left\ud ventricular hypertrophy, peripheral vascular disease,\ud renal impairment, or target organ damage.\ud Main outcome measures 10 year risk estimates.\ud Results People of African origin had the lowest 10\ud year risk estimate of CHD adjusted for age and sex\ud (7.0%, 95% confidence interval 6.5 to 7.5) compared\ud with white people (8.8%, 8.2 to 9.5) and south Asians\ud (9.2%, 8.6 to 9.9) and the highest estimated risk of\ud stroke (1.7% (1.5 to 1.9), 1.4% (1.3 to 1.6), 1.6% (1.5 to\ud 1.8), respectively). The estimate risk of combined\ud CVD, however, was highest in south Asians (12.5%,\ud 11.6 to 13.4) compared with white people (11.9%,\ud 11.0 to 12.7) and people of African origin (10.5%, 9.7\ud to 11.2). In the subgroup of 1069, the probability that\ud a risk of CHD >15% would identify risk of combined\ud CVD >20% was 91% in white people and 81% in\ud both south Asians and people of African origin. The\ud use of thresholds for risk of CHD of 12% in south\ud Asians and 10% in people of African origin would\ud increase the probability of identifying those at risk to\ud 100% and 97%, respectively.\ud Conclusion Primary care doctors should use a lower\ud threshold of CHD risk when treating mild\ud uncomplicated hypertension in people of African or\ud south Asian origin

Topics: RA
Publisher: BMJ Group
Year: 2002
OAI identifier:

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