Framingham risk score and prediction of coronary heart disease death in young men

doi:10.1016/j.ahj.2007.03.042

American Heart Journal

Volume 154, Issue 1, July 2007, Pages 80-86

https://doi.org/10.1016/j.ahj.2007.03.042 Get rights and content

Background

We tested the ability of the Framingham Risk Score (FRS) and the online ATP III risk estimator to estimate risk and to predict 10-year and longer-term coronary heart disease (CHD) death in younger adults (age 18-39 years). Although prediction with individual risk factors has been tested in individuals <30 years, current multivariate risk prediction strategies have not been applied to prediction of clinical CHD in this age range.

Methods

We included 10 551 male participants of the CHA study who were aged 18 to 39 years and free of baseline CHD and diabetes at enrollment from 1967 to 1973. Risk of CHD was estimated using both FRS and ATP III online risk estimator for each individual. Men were stratified into deciles according to the magnitude of predicted risk calculated from measured baseline risk factors (CHA-predicted risk). Observed CHD mortality rates for 10, 20, and 30 years of follow-up were compared with estimated risks. Death rates of CHD were low across 30 years of follow-up.

Results

The FRS remained <10% for all deciles of CHA-predicted risk in the 18- to 29-year-old cohort. Framingham-predicted risk reached 12% only in the 30- to 39-year-old cohort in the highest decile of CHA-predicted risk despite substantial risk factor burden.

Conclusions

Neither method classified individuals <30 years as high risk despite substantial risk factor burden. Future clinical guidelines should consider alternative strategies to estimate and communicate risk in populations <30 years.

Section snippets

Baseline examination

From November 1967 to January 1973, the CHA (Chicago Heart Association Detection Project in Industry) study screened 39 522 men and women aged ≥18 years of varied socioeconomic backgrounds and ethnicities employed at 84 Chicago-area businesses. As previously reported in detail, standardized examination methods were used.17, 18 Trained staff measured height, weight, supine blood pressure using a standard mercury sphygmomanometer, and serum total cholesterol from a nonfasting blood sample.¹⁹

Baseline characteristics

Table I shows baseline characteristics of the 2 different age cohorts in the study sample. The younger cohort had a slightly lower BMI, a lower percentage of overweight or obesity, and a substantially lower total cholesterol compared with the older men.

Prediction of CHD Risk

The participants were stratified into deciles of predicted risk for CHD death based on the CHA risk score, with decile 1 as the lowest and decile 10 as the highest predicted risk (Table II). Each individual was also assigned a risk estimate using

Discussion

There were several important findings in this study. First, as expected, CHD death rates were low across 10, 20, and 30 years of follow-up for young men, particularly among the 18- to 29-year-old cohort. The predicted risk using either the online or the FRS-calculated version remained <10% for all participants in the 18- to 29-year-old cohort and only reached 12% in the 30- to 39-year-old cohort in the highest decile of the CHA risk score. Despite these low risk estimates by both the FRS and

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: We acknowledge the support by the American Heart Association, Dallas, TX, and its affiliates in Chicago, IL; the National Heart, Lung, and Blood Institute, Bethesda, MD, for grants R01-HL 15174, R01-HL 21010, and R01-HL 03387; and the Chicago Health Research Foundation, Chicago, IL. A list of colleagues who contributed to earlier aspects of this work has been published (Cardiology. 1993;82:191-222). Dr Berry received support from a Ruth Kirschstein National Research Service Award/National Heart, Lung, and Blood Institute fellowship (T32HL069771) at Northwestern University Feinberg School of Medicine, Chicago, IL.

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Clinical InvestigationCoronary Artery DiseaseFramingham risk score and prediction of coronary heart disease death in young men

Background

Methods

Results

Conclusions

Section snippets

Baseline examination

Baseline characteristics

Prediction of CHD Risk

Discussion

J Chronic Dis

Clin Chim Acta

Am J Cardiol

Lancet

J Am Coll Cardiol

Major risk factors as antecedents of fatal and nonfatal coronary heart disease events

JAMA

Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age

Circulation

Prevention Conference V: beyond secondary prevention: identifying the high-risk patient for primary prevention: executive summary

Circulation

Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals

JAMA

Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults

N Engl J Med

Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report

Circulation

Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults

N Engl J Med

Risk factors for coronary heart disease in men 18 to 39 years of age

Ann Intern Med

Serum cholesterol in young men and subsequent cardiovascular disease

N Engl J Med

Intensive lipid lowering with atorvastatin in patients with stable coronary disease

N Engl J Med

Intensive versus moderate lipid lowering with statins after acute coronary syndromes

N Engl J Med

Explaining risks: turning numerical data into meaningful pictures

BMJ

Tracking women's awareness of heart disease: an American Heart Association national study

Circulation

Self-reported use of mammography among women aged > or = 40 years—United States, 1989 and 1995

MMWR Morb Mortal Wkly Rep

Pathobiological determinants of atherosclerosis in youth risk scores are associated with early and advanced atherosclerosis

Pediatrics

Clinical Investigation
Coronary Artery Disease
Framingham risk score and prediction of coronary heart disease death in young men