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Korean Journal of Epidemiology 2006;28(2): 162-170.
Framingham Equation Model Overestimates Risk of Ischemic Heart Disease in Korean Men and Women.
Kyung A Ahn, Ji Eun Yun, Eo Rin Cho, Chung Mo Nam, Yangsu Jang, Sun Ha Jee
1Graduate School of Public Health, Yonsei University, Korea.jsunha@yumc.yonsei.ac.kr
2Institute for Health Promotion, Korean Metabolic SyndromeResearch Initiatives, Yonsei University College of Medicine,Korea.
3Cardiovascular Genome Center, Korea.
BACKGROUND: The prediction of the absolute risk of ischemic heart disease (IHD) is commonly based on the risk prediction equations, originated from the Framingham Heart Study.
Framingham equation model was applied to participants from 2001 Korean National Health and Nutrition Examination Survey (KNHNES) to estimate the 5 year risk of IHD among Koreans ranging from 30 to 74 year-olds. The estimated risks were compared to the incidence and admission rates from two statistical reports among Koreans. Five year admission rate was estimated by the annual report from National Health Insurance Corporation (NHIC).
The average ages (standard deviation) were 34.31(27.23) year-old for KNHNES and 48.26(12.87) year-old for Framingham population used in this study. The risk of IHD predicted by the Framingham equation model substantially exceeded the risks actually reported in Korea. Five-year predicted risks by Framingham equation model were 4.86% for men and 1.93% for women; whereas from incidence data in Korea, five-year risks for acute myocardial infarction (AMI) were for 0.47% for men and 0.18% for women. These AMI incidence was similar to the admission rate (0.34 for men and 0.15 for women) estimated by NHIC. Also, 5-year admission rate of IHD were 1.16 for men and 0.78 for women. The magnitude of risk overestimation by Framingham mode is approximately at least 150 to 320%.
Korean guidelines for the management for high risk group of IHD need to develop and correct for overestimation to avoid inflation of costs in primary prevention.
Keywords: Framingham model; Ischemic heart disease risk; Incidence; Admission


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