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Avins AL, Browner WS. Improving the Prediction of Coronary Heart Disease to Aid in the Management of High Cholesterol Levels: What a Difference a Decade Makes. JAMA. 1998;279(6):445–449. doi:10.1001/jama.279.6.445
From the General Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, Calif, and the Department of Epidemiology and Biostatistics, University of California, San Francisco.
Context.— A patient's coronary heart disease (CHD) risk must be correctly classified
to successfully apply risk-based guidelines for treatment of hypercholesterolemia.
Objective.— To determine the classification accuracy of the National Cholesterol
Education Program (NCEP) CHD risk-stratification system and compare it with
a simple revised system that gives greater weight to age as a CHD risk factor.
Design.— Modeling of 10-year CHD risk, using equations from the Framingham Heart
Study applied to a cross-sectional survey of the US population.
Subjects.— The 3284 subjects aged 20 to 74 years surveyed in the Second National
Health and Nutrition Examination Survey (1978-1982) who had fasting lipid
Main Outcome Measures.— The area under the receiver operating characteristic curve (AUC) for
10-year CHD risk for the NCEP and revised scales.
Results.— Among all adults with a low-density lipoprotein cholesterol value of
at least 4.1 mmol/L (160 mg/dL), the NCEP system showed fairly good discrimination
(AUC=0.90), though there was a substantial decline among men 35 to 74 years
old and women 55 to 74 years old (AUC=0.81). By contrast, the revised system
showed superior performance in all hypercholesterolemic adults (AUC=0.94-0.97)
as well as in the subgroup of men 35 to 74 years old and women 55 to 74 years
Conclusions.— Simple modifications of the NCEP treatment criteria result in a substantially
improved ability to discriminate between higher and lower CHD risk groups.
Unlike the NCEP system, this revised system retains its classification ability
in all age groups studied.
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