Abstract
We investigated whether the Framingham risk score, which was designed to estimate
the 10-year risk of coronary heart disease (CHD), differentiates lifetime risk for
CHD. All subjects in the Framingham Heart Study examined from 1971 to 1996 who were
free of CHD were included. Subjects were stratified into age- and gender-specific
tertiles of Framingham risk score, and lifetime risk for CHD was estimated. We followed
2,716 men and 3,500 women; 939 developed CHD and 1,363 died free of CHD. At age 40
years, in risk score tertiles 1, 2, and 3, respectively, the lifetime risks for CHD
were 38.4%, 41.7%, and 50.7% for men and 12.2%, 25.4%, and 33.2% for women. At age
80 years, risks were 16.4%, 17.4%, and 38.8% for men and 12.8%, 22.4%, and 27.4% for
women. The Framingham risk score stratified lifetime risk well for women at all ages.
It performed less well in younger men but improved at older ages as remaining life
expectancy approached 10 years. Lifetime risks contrasted sharply with shorter term
risks: at age 40 years, the 10-year risks of CHD in tertiles 1, 2, and 3, respectively,
were 0%, 2.2%, and 11.6% for men and 0%, 0.7%, and 2.3% for women. The Framingham
10-year CHD risk prediction model discriminated short-term risk well for men and women.
However, it may not identify subjects with low short-term but high lifetime risk for
CHD, likely due to changes in risk factor status over time. Further work is needed
to generate multivariate risk models that can reliably predict lifetime risk for CHD.
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References
- Prediction of coronary heart disease using risk factor categories.Circulation. 1998; 97: 1837-1847
- 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. 2002; 106: 3143-3421
- Validation of the Framingham coronary heart disease prediction scores.JAMA. 2001; 286: 180-187
- Prevention of coronary heart disease in clinical practice.Atherosclerosis. 1998; 140: 199-270
- Joint British recommendations on prevention of coronary heart disease in clinical practice.Heart. 1998; 80: S1-S29
- Prevention conference V. Beyond secondary prevention.Circulation. 2000; 101: e3-e11
- Prevention conference V. Beyond secondary prevention.Circulation. 2000; 101: 111-116
- Lifetime risk for coronary heart disease by cholesterol levels at selected ages.Arch Intern Med. 2003; 163: 1966-1972
- Lifetime risk of developing coronary heart disease.Lancet. 1999; 353: 89-92
- Lifetime risks of hip, Colles', or vertebral fracture and coronary heart disease among white postmenopausal women.Arch Intern Med. 1989; 149: 2445-2448
- Effect of risk factor values on lifetime risk of and age at first coronary event. The Adventist Health Study.Am J Epidemiol. 1995; 142: 746-758
- An approach to longitudinal studies in a community.Ann NY Acad Sci. 1963; 107: 539-556
- The Framingham Offspring Study. Design and preliminary data.Prev Med. 1975; 4: 518-525
Abbott RD, McGee DL. The Framingham Study: an epidemiological investigation of cardiovascular disease, section 37: the probability of developing certain cardiovascular diseases in eight years at specified values of some characteristics. Bethesda, MD: National Heart, Lung and Blood Institute, 1987
SAS/STAT User's Guide, Version 8. Cary, NC: SAS Institute, Inc., 1999
- Lifetime risk of dementia and Alzheimer's disease.Neurology. 1997; 49: 1498-1504
- Residual lifetime risk for developing hypertension in middle-aged women and men.JAMA. 2002; 287: 1003-1010
- Nonparametric estimation from incomplete observations.J Am Stat Assoc. 1958; 53: 457-481
- On the use of cause-specific failure and conditional failure probabilities.J Am Stat Assoc. 1993; 88: 402-409
Article info
Publication history
Accepted:
March 19,
2004
Received in revised form:
March 19,
2004
Received:
October 16,
2003
Footnotes
☆Dr. Lloyd-Jones is supported by grant 1 K23 HL04253 from the National Institutes of Health, Bethesda, Maryland. The Framingham Heart Study is supported by contract N01-HC-25195 from the National Institutes of Health/National Heart, Lung, and Blood Institute, Bethesda, Maryland.
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Copyright
© 2004 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
