Common clinical practice versus new PRIM score in predicting coronary heart disease risk

Abstract

Objectives To compare the new Patient Rule Induction Method (PRIM) Score and common clinical practice with the Framingham Point Score for classification of individuals with respect to coronary heart disease (CHD) risk. Methods and results PRIM Score and the Framingham Point Score were estimated for 11,444 participants from the Copenhagen City Heart Study. Gender specific cumulative incidences and 10 year absolute CHD risks were estimated for subsets defined by age, total cholesterol, high-density lipoprotein (HDL) cholesterol, blood pressure, diabetes and smoking categories. PRIM defined seven mutually exclusive subsets in women and men, with cumulative incidences of CHD from 0.01 to 0.22 in women, and from 0.03 to 0.26 in men. PRIM versus Framingham Point Score found 11% versus 4% of all women, and 31% versus 35% of all men to have 10 year CHD risks > 20%. Among women ≥ 65 years with hypertension and/or with diabetes, 10 year CHD risk > 20% was found for 100% with PRIM scoring but for only 18% with the Framingham Point Score. Conclusion Compared to the PRIM Score, common clinical practice with the Framingham Point Score underestimates CHD risk in women, especially in women ≥ 65 years with hypertension and/or with diabetes.