Framingham Risk Scoring

The Framingham coronary prediction method estimates the risk of coronary health disease (CHD) over the course of 10 years. Angina pectoris, myocardial infarction (heart attack), and death from coronary disease are considered CHD for the purposes of the scoring. Other heart and vascular diseases are not included.

The factors used to calculate the score include age, sex, total cholestorol level (mg/dl), HDL cholesterol level (mg/dl), systolic blood pressure (mm/Hg), and whether the person smokes. The answer is given as a percentage.

The FRS applies only to people without known heart disease. Although it is often used by doctors to determine whether statin therapy is desirable, experts caution against using the FRS in isolation as a diagnostic tool. Other factors should be considered.

The 10-year hazards of CHD are overall high in older persons which might over-identify patients requiring aggressive interventions. Relative risk estimates (risk in comparison with low risk individuals) may be more useful than absolute risk estimates in the elderly. Similarly, because the score estimates the risk of developing CHD within a 10-year time period, the . This risk score may not adequately reflect the long-term or lifetime CHD risk of younger adults.

A recent large-scale study of men under age 30 with no history of heart problems found the FRS was not effective in predicting problems. The system is much more accurate in older people. There has also been suggestion that the system underestimates risk among lower socioeconomic groups. The medical profession has come to understand the limitations of FRS but still finds it useful. Additional tests for atherosclerosis are under development. A system called the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) score has been developed for people ages 15 to 34.

The federal government offers an online calculator for figuring your risk. http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=prof

Criticism of the Framingham Risk Score

The great thing about the FRS is that it can be calculated from only a few parameters. The downside is that the accuracy has left something to be desired. Over time, clinicians found they could improve the predictions if they extended the model with additions of the C-reactive protein level in tbe blood and whether a parent had experienced a heart attack at an early age.

Reynolds Risk Score

The Reynolds Risk Score was recently invented as an alternative to the Framingham Risk Score. It incorporated high-sensitivity C-reactive protein levels and parental history into the calculation. A study on over 20,000 women found the Reynolds Risk Score predicted risk as accurately as the FRS for those at high risk and those at low risk. For those at medium or moderate risk, the Reynolds Score was more accurate. A more recent study on men found that the Reynolds Score is more accurate than the Framingham Risk Score.

An on-line tool for calculating the Reynolds Risk Score is available at

http://www.reynoldsriskscore.org/

It doesn't apply to people with diabetes. If requires your age, sex, blood pressure, serum cholesterol levels (total and HDL), C-reactive protein level (available from a blood analysis), and whether one of your parents had a heart attack before age 60.

Abstract on its development.