Original Scientific Paper Estimation of cardiovascular risk: a comparison between the Framingham and the SCORE model in people under 60 years of age Tjarda Scheltens a , W.M. Monique Verschuren b , Hendriek C. Boshuizen b , Arno W. Hoes a , Nicolaas P. Zuithoff a , Michiel L. Bots a and Diederick E. Grobbee a a Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht and b National Institute for Public Health and the Environment, Bilthoven, The Netherlands Received 6 September 2007 Accepted 24 April 2008 Background The Framingham Heart Study risk model has been used in the majority of cardiovascular risk management guidelines. Recently, a new model based on the SCORE system has been proposed. We compared both risk models with regard to their ability to predict cardiovascular mortality in the Netherlands. Design Cohort study. Methods In a Dutch cohort study of 39 719 persons, three properties of the risk models were investigated: discriminating ability (ranking persons in order of risks, expressed in area under the curve); calibrating ability (prediction of events compared with actual events expressed in goodness of fit); and the number of persons assigned to treatment according to the guideline. Results The discriminative ability of both models was similar: the area under the curve of Framingham was 0.86 and of SCORE 0.85. Calibration of both functions was inadequate. The goodness of fit of the SCORE model was 35 and of the Framingham model 64, whereas a goodness of fit less than 20 is considered acceptable. Using the Dutch guideline treatment threshold of 10% mortality risk, the SCORE risk function assigned 0.4% of the population to drug treatment where the Framingham function assigned 0.7%. Conclusion The findings of this study show that both the SCORE and the Framingham model function have a good discriminative ability but are insufficient in predicting absolute risks. SCORE assigned fewer participants to treatment than Framingham. If a new risk model is implemented in treatment guidelines, comparison with the model in use and evaluation of calibrating features is needed. Eur J Cardiovasc Prev Rehabil 15:562–566  c 2008 The European Society of Cardiology European Journal of Cardiovascular Prevention and Rehabilitation 2008, 15:562–566 Keywords: cardiovascular diseases, cohort studies, forecasting, risk factors Introduction The development of cardiovascular disease (CVD) is strongly related to a number of risk factors, and risk factor reduction can prevent or postpone the occurrence of CVD [1]. Estimates of absolute CVD risk in healthy patients are usually calculated from risk prediction models derived from prospective, observational studies such as the Framingham Heart Study [2], the Mu ¨nster Study [3], the Scottish Heart Health Study [4], or the British Regional Heart Study [5]. In the Netherlands, until recently a Framingham risk model was used that allows prediction of risk of a combination of vascular diseases, notably myocardial infarction, death from coronary heart disease, angina pectoris, coronary insufficiency, stroke, transient ischemia, congestive heart failure, and peripheral vascular disease [2]. In 2006, a new guideline on cardiovascular risk management was issued and the SCORE risk prediction model was introduced [6]. Correspondence to Dr Tjarda Scheltens, MD, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands Tel: + 3188 7568052; fax: + 3188 7568099; e-mail: t.scheltens@umcutrecht.nl 1741-8267  c 2008 The European Society of Cardiology DOI: 10.1097/HJR.0b013e3283063a65 Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.