Coronary heart disease (CHD) is common and includes the diagnoses angina pectoris, myocardial infarction, and coronary disease death. Predicting the first occurrence of these events is important and may affect clinical decisions and care. It can be expected that more than a third of adult Americans will develop CHD during their lifetime,1 and improvements in diagnosis and care may provide great benefits.
The article by Tzoulaki and colleagues2 assesses the scientific literature concerning efforts to improve the prediction of CHD over and above the Framingham risk score.3 The authors report that many articles have provided information on new risk factors, but the study designs and data analyses in those reports raise concerns about the usefulness of the new information and about how improvement over the Framingham risk score was assessed. Researchers and clinicians should understand how CHD risk estimation is undertaken and evaluated, as these methods are frequently used to assess risk of developing disease across a variety of health disciplines.4
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