Why the Framingham (or any) risk score can never be a ‘perfect’ predictor
There are several factors. First, Framingham can never be truly predictive once applied to a different population – its data were obtained from a North-Eastern American, predominantly middle-class, urban, Caucasian population. Second, some age–gender groups were rather small, making these underpowered to provide anything like a reliable predictive estimate of cardiovascular risk. Third, with infallible 20:20 hindsight (not available to Framingham’s originators), several risk factors might now reasonably be added to improve ‘predictive accuracy’, not least