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