Framingham Heart Study to Help Predict Atherosclerotic Cardiovascular Risks in Patients

Framingham Heart Study to Help Predict Atherosclerotic Cardiovascular Risks in Patients
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The major risk factors for developing cardiovascular diseases are age, sex, high blood pressure, smoking, dyslipidemia, and diabetes. These risk factors also cluster and interact to increase cardiovascular risk.

Data from the Framingham study has been used to develop multivariable risk prediction algorithms to assess the risk of all atherosclerotic cardiovascular diseases (CVD) or subclasses of cardiovascular diseases, such as coronary heart disease (CHD), stroke, peripheral vascular disease, and heart failure.The estimation of CVD risk allows identification of the risk factors that are most critical and the treatments that are most cost-effective.

An example of such algorithm is the CHD risk assessment tool (Wilson et al.,2001), which has been validated against CHD data in populations in United States, Europe, Mediterranean regions and Asia. This tool was incorporated into the Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III), and has been widely used by physicians.

Most recently, D’Agostino et al.(2008) used the Framingham study to develop a single multivariable risk function that predicts risk of developing all CVD and of its components. The model uses the following risk factors: age, total cholesterol, HDL cholesterol, systolic blood pressure, smoking, diagnosed with diabetes, and gender.

Other prediction tools for risk of cardiovascular diseases include

  • the scoring system developed by the Prospective Cardiovascular Munster Study (PROCAM) to predict acute coronary events

  • the Reynolds risk score developed by Ridker et al (2007) to predict CVD in women. The Reynolds risk score is based on family history of CVD, high-sensitivity C-reactive protein, and hemoglobin A1C (the latter in individuals with diabetes).

  • the HEARTSCORE system, developed by the Systematic Coronary Risk Evaluation (SCORE), to predict fatal CVD

  • the QRISK score, using the QRESEARCH database

  • the ASSIGN risk score, based on the Scottish Heart Health Extended cohort.

Data from the Framingham study can be downloaded from the Nationational Heart Blood and Lung Institute (https://www.nhlbi.nih.gov/resources/deca/teaching.htm).

Sources

Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H,Kannel WB. Prediction of coronary heart disease using risk factor categories.Circulation. 1998;97:1837–1847.

Wolf PA, D’Agostino RB, Belanger AJ, Kannel WB. Probability of stroke: a risk profile from the Framingham study. Stroke. 1991;22:312–318.