Lab-based = non-lab-based models for CVD prediction

Clinical Question

Are risk prediction methods using laboratory testing and methods not using laboratory testing comparable in predicting cardiovascular events?

Bottom Line

Cardiovascular prediction models that do not require laboratory testing perform as well as models that use laboratory testing. (LOE = 2b)


Gaziano TA, Young CR, Fitzmaurice G, Atwood S, Gaziano JM. Laboratory-based versus non-laboratory-based method for assessment of cardiovascular disease risk: the NHANES I Follow-up Study cohort. Lancet 2008;371(9616):923-931.  [PMID:18342687]

Study Design

Cohort (prospective)






Since most of the world's cardiovascular deaths occur in developing countries where laboratory testing is a costly luxury, these researchers sought to determine if cardiovascular prediction models that don't use laboratory testing perform as well as those that do. To do this, they identified nearly 6200 patients with no known heart disease and used Framingham-based prediction models to estimate cardiovascular disease risk. In the Framingham model, cholesterol levels are used along with other factors. These researchers replaced body mass index for cholesterol in the nonlaboratory-based model. The patients had completed a comprehensive set of surveys and tests in the 1970s and their vital status was assessed 20 years later. The research team obtained medical records, pathology reports, electrocardiograms, and so forth to confirm diagnoses. Finally, they evaluated the performance of the models on men and on women. During the 21 years of follow up, 38% of the patients died from cardiovascular disease and there were more than 1500 first-time cardiovascular events. For women, both prediction models were 83% accurate. For men, both models were 78% accurate.