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Background: A number of prediction models have been developed in an attempt to accurately identify patients at increased risk of a first coronary heart disease event. We sought to determine the ten-year incidence of coronary heart disease events in a healthy cohort with measurable risk factors, and to compare these results with the predicted number of events by use of both the Framingham and European Society of Cardiology risk prediction models., Methods: We compared the predicted and observed number of events in 5 risk categories in 1393 subjects aged 30 to 74 years who were enrolled in the Normative Aging Study., Results: The risk prediction models reliably stratify populations with regards to relative risk of coronary heart disease events and there is reasonable agreement between the 2 models (weighted kappa = 0.46, P <.01). The Framingham model underestimated the absolute risk of coronary heart disease events in the low-risk group, and both risk prediction models overestimated the absolute risk of events in the high- or very-high-risk groups (Framingham c-statistic = 0.60, European Society of Cardiology c-statistic = 0.58)., Conclusions: Despite simplification, the accuracy of the European model was not significantly different from the Framingham model. But the accuracy of absolute risk prediction, particularly at the extremes of risk, is imperfect. Refinement and validation of these risk prediction models is important because they affect the management of individual patients and the allocation of community resources.