Stroke, Vol 25, 802-807, Copyright © 1994 by American Heart Association
T Truelsen, E Lindenstrom and G Boysen
BACKGROUND AND PURPOSE: We wished to test the validity of a stroke
probability point system from the Framingham Study for a sample of the
population of Copenhagen, Denmark. In the Framingham cohort, the regression
model of Cox established the effect on stroke of the following factors:
age, systolic blood pressure, the use of antihypertensive therapy, diabetes
mellitus, cigarette smoking, prior cardiovascular disease, atrial
fibrillation, and left ventricular hypertrophy. Derived from this model,
stroke probabilities were computed for each sex based on a point system.
The authors claimed that a physician can use this system for individual
stroke prediction. METHODS: The Copenhagen City Heart Study is a
prospective survey of 19,698 women and men aged 20 years or older invited
to two cardiovascular examinations at 5-year intervals. The baseline
examination included 3015 men and 3501 women aged 55 to 84 years; 474
stroke events occurred during 10 years of follow-up. In both cohorts
initial cases of stroke and transient ischemic attack recorded during 10
years of follow-up were used. We used the statistical model from the
Framingham Study to establish a corresponding stroke probability point
system using data from the Copenhagen City Heart Study population. We then
compared the effects of the relevant risk factors, their combinations, and
the corresponding stroke probabilities. We also assessed stroke events
during 10 years of follow-up in several subgroups of the Copenhagen
population with different combinations of risk factors. RESULTS: For the
Copenhagen City Heart Study population some of the risk factors (diabetes
mellitus, cigarette smoking, atrial fibrillation, and left ventricular
hypertrophy) had regression coefficients different from those of the
Framingham Study population. Consequently, the probability of stroke for
persons presenting these risk factors and their combinations varied between
the two studies. For some other risk factors (age, blood pressure, and
cardiovascular disease), no major differences were found. The recorded
frequency of stroke events in subgroups of the Copenhagen population was
compatible with the estimated probability intervals of stroke from the
Copenhagen City Heart Study and with those from the Framingham Study, but
these intervals were very large. CONCLUSIONS: The majority of risk factors
for stroke identified by the Framingham Study also had a significant effect
in the Copenhagen City Heart Study population. The differences found could
be due partly to different definitions of these factors used by the two
studies. Although estimated stroke probabilities based on point systems
from the Copenhagen City Heart Study and the Framingham Study were similar,
the points scored in the two systems did not always correspond to the same
combination of risk factors. Such systems can be used for estimating stroke
probability in a given population, provided that the statistical confidence
limits are known and the definitions of risk factors are compatible.
However, because of the large statistical uncertainty, a prognostic index
should not be applied for individual prediction unless it is used as an
indicator of high relative risk associated with the simultaneous presence
of several risk factors.
ARTICLES
Comparison of probability of stroke between the Copenhagen City Heart Study and the Framingham Study
Department of Neurology, Hvidovre Hospital, Denmark.
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