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Thursday, 17. May 2012

Framingham Risk Assessment Tool for Estimating 10-year Risk of Developing Hard CHD (Myocardial Infarction and Coronary Death)1


Suited for:
- Individuals free of CHD, intermittent claudicatio and diabetes,
- 30-79 years of age

What is your gender? Male Female
What is your age (in years)? years (30-79 years)
What is your cholesterol level? mg/dl (135-330 mg/dl)
What is your HDL-cholesterol level? mg/dl (25-99 mg/dl)
What is your systolic blood pressure? mmHg (95 - 185 mmHg)
Do you take tablets for high blood pressure? No Yes
Have you smoked cigarettes within the past month? No Yes
1. National Cholesterol Education Program (Adult Treatment Panel III) JAMA 2001; 285:2486-2495

Important notes


Does the Framingham risk function overestimate risk in Germany?

Across different populations, significant variations of absolute risk exist among persons with similar risk profiles. For this reason, a score derived in one population may give an incorrect estimate of absolute risk when used in another. Coronary risk predicted by the Framingham risk function substantially exceeds the risk actually observed e.g. in German cohorts (PROCAM, MONICA Augsburg); the magnitude of risk overestimation in this case is at least 50%.1


CHD risk assessment in Diabetes mellitus

Certain opinion leaders suggest that diabetes mellitus should be considered a coronary risk equivalent with the therapeutic implication to lower LDL-C in such individuals to < 100 mg/dl. Other opinion leaders recommend that the cardiovascular prognosis for type 2 DM depends on multiple variables (e.g. age, duration of DM, degree of optimization of serum lipid levels and blood pressure, other comorbid conditions).

These differences in opinion are reflected in different algorithms: the Framingham risk function ignores diabetes mellitus, while in the PROCAM risk function diabetes mellitus is a covariable for risk estimation.


References

  1. Hense HW, Schulte H, Löwel H, Assmann G, Keil U: Framingham risk function overestimates risk of coronary heart disease in men and women from Germany - results from the MONICA Augsburg and the PROCAM cohorts. Eur Heart J 2003;24:937-945.