Evaluating risk for cardiovascular diseases--vain or value? How do different cardiovascular risk scores act in real life.

BACKGROUND Screening tools to identify persons with high cardiovascular risk exist, but less is known about their validity in different population groups. The aim of this article is to compare the sensitivity and specificity of three different cardiovascular disease risk scores and their ability to detect high-risk individuals in daily practice. METHODS The sensitivity and specificity of risk charts based on Framingham Risk Function, SCORE and cardiovascular disease (CVD) Risk Score were analysed using a large population risk factor survey database in Finland. For different cardiovascular disease end-points in 10-year follow-up true positive, false positive, true negative and false negative cases were identified using different risk charts. Subjects over 40 years (n = 25 059) of the FINRISK Study were used in analyses. RESULTS Risk scores differed depending on gender, age and cardiovascular outcome. Among men the sensitivity of CVD Risk Score and Framingham Risk Function at risk of >or=10% for each end point was higher than of SCORE or Framingham Risk Function at risk of 20%. The specificity of Framingham Risk Function at risk of 20% was higher than the specificity of other risk charts. Among women in all endpoints the sensitivity was highest in CVD Risk Score and lowest in Framingham Risk Function at risk of >or=20%. Specificity for all different endpoints was highest in SCORE and Framingham Risk Function at risk of 20%. CONCLUSIONS Sensitivity and specificity varied markedly in between three cardiovascular risk evaluation tools. Practitioners should be aware of their limitations especially when estimating risk among women and younger patients.