This Article Free upon publication Full Text Full Text (PDF) CME: Take the course for this article: Circulation: August 4, 2009, Volume 120, Number 5 Data Supplement All Versions of this Article: 120/5/384    most recent CIRCULATIONAHA.108.835470v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Google Scholar Articles by Marma, A. K. Articles by Lloyd-Jones, D. M. PubMed PubMed Citation Articles by Marma, A. K. Articles by Lloyd-Jones, D. M. Related Collections Health policy and outcome research Risk Factors Epidemiology

(Circulation. 2009;120:384-390.)
© 2009 American Heart Association, Inc.

Epidemiology

Systematic Examination of the Updated Framingham Heart Study General Cardiovascular Risk Profile

Amanda K. Marma, MD; Donald M. Lloyd-Jones, MD, ScM

From the Department of Preventive Medicine and Bluhm Cardiovascular Institute, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill.

Correspondence to Donald M. Lloyd-Jones, MD, ScM, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Dr, Suite 1102, Chicago, IL 60611. E-mail dlj{at}northwestern.edu

Received November 13, 2008; accepted May 22, 2009.

Background— An updated Framingham risk prediction tool was recently published. It features an expanded end point of general cardiovascular disease and a "vascular age" risk communication analogy.

Methods and Results— We systematically examined the tool to determine which risk factor combinations allow risk thresholds to be reached and how different risk factor burdens translate into vascular age. We varied risk factor levels in isolation and combination and observed risk output patterns, with high risk defined as 20% 10-year predicted risk. As expected, we found that age is the major determinant of 10-year predicted risk for both men and women. Younger individuals tend not to exceed 20% 10-year risk even with multiple risk factors, although with marked risk factor burden, including both smoking and diabetes mellitus, men as young as 35 years of age and women as young as 40 years of age can be classified as high risk. For the risk factor levels we entered, predicted risk ranges from 3.1% to 46.8% for a 45-year-old man and 2.4% to 42.7% for a 55-year-old woman. Likewise, vascular age ranges from 37 to >80 years for a 45-year-old man and 39 to >80 years for a 55-year-old woman.

Conclusions— The inclusion of noncoronary end points in this tool expands the range of predicted risks for men and women at all ages studied. Nevertheless, many younger individuals with high risk factor burden have low 10-year predicted risk. Wide ranges of "vascular age" are available for most chronological ages to assist with risk communication.

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