Three calculators to estimate the ten year risk of CHD and CVD with algorithms on risk factors originating from the SCORE project, FRAMINGHAM study and PROCAM study (PROCAM algorithm for men only) and regional adjustment factors of prevalence according to the MONICA project. A comparison of cardiovascular riskengines designed by Romanens and Ackermann , Dec 9th 2004 , version RA1.
   SCORE   FRAMING Algorithm Algorithm Weibull Weibull (mortality) (events) Primary CareRisk Calculator Male  ;   Female Premenopause                                          Menopause Age (years) Total Cholesterol (mmol/l) HDL-C (mmol/l) LDL-C (mmol/l) TGL (mmol/l) BP systolic (mm Hg) Smoker ? Diabetes mellitus (FBG > 6.66 mmol/l) ? Premature CAD in family (1st°) ? LV-Hypertrophy by ECG ? Prevalence adjustment factor according to the selected MONICA region on the right Results 10 Yr Risk [%] of hard CHD (AMI) FRAMINGHAM,PROCAM: fatal & non-fatal SCORE: fatal only LRP :  HRP: SCORE: 10 Yr Risk [%] of fatal non-CHDCVD in LowRisk- & HigRisk-Populations LRP :  HRP: SCORE: 10 Yr Risk [%] of fatal CVD in LowRisk- & HigRisk-Populations LRP :  HRP:

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MONICA PV men
MONICA PV women

Sources

Remarks about the principles of calculating and how to use the PROCAM option in this CHD / CVD riskcalculator.

1.) In the PROCAM calculation option you are computing with the PROCAM-algorithm for men statistically based on the Cox proportional hazards model in the PROCAM cohort with 325 ACE (fatal and non fatal) in 4818 men aged 35-65 years within 10 years. As typical for Cox-algorithms, you reach always a 100 % 10 year risk, if you compute with "full power" (meaning all risk factors as high as possible).

2.) In the PROCAM output field you receive as result the original, regional non adapted PROCAM posttest probability (P %) using the algorithm for men, if sex selection is male. If sex selection is female (premonopausal or menopausal) you get strictly a P % of men corrected by a reduction factor of 0.25 (if there is no Diabetes), according the recommendation of PROCAM.

3.) In the MONICA output field you receive a P % result epidemiological corrected by regional adjustment factors for men or women described in the procam pocket guide. You may define these factors (MRAF's) either by selection out of the regionlist or by manual input in the fields MONICA PV for men / women. On purpose not to falsify the original Bayes kernel (likelihoodratio, LR) of the PROCAM-algorithm for men, in this calculator MRAF's are used to correct the pretest-probability (prevalence, PV) and not to correct directly the posttest-probability as recommended in the Procam-pocket-guide. Finaly the calculation of the posttest-probability is fulfilled in two steps: first by computing the specific LR out of the algorithm for men (using the PROCAM PV 325/4818), second by using this LR upon the MRAF-corrected PROCAM PV in a FAGAN-calculation (computed in hazard odds).
In the MONICA output field you receive a regional adjusted posttest-10 year probability P % according the chosen MRAF's described above, either using MRAF for men if sex selection is "male" or using MRAF for women if sex selection is "women postmenopausal". Warning: by using sex selection "women premenopausal", you may perhaps receive an overcorrected result based on an overcorrected PROCAM-PV, namely 0.25 * MRAF for women * PROCAM-PV for men.

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Dr. med. Franz Paul Ackermann-Ball
Spezialarzt FMH für Innere Medizin
Ziegelfeldstr. 30 , CH-4600 OLTEN
TN +41 (0)62 212 15 77

Dez 12th 2004
Last revision May 26th 2006
MONICA-PROCAM3_RA1.html , Version 2.1 (Java-Script.js integriert)

Special Edition Dr. med. M. Romanens
FMH Kardiologie , Olten
.F.A.