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(Circulation. 1998;97:1837-1847.)
© 1998 American Heart Association, Inc.

Special Reports

Prediction of Coronary Heart Disease Using Risk Factor Categories

Peter W. F. Wilson, MD; Ralph B. D'Agostino, PhD; Daniel Levy, MD; Albert M. Belanger, BS; Halit Silbershatz, PhD; ; William B. Kannel, MD

From the Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, Mass (P.W.F.W., D.L.); Boston University Mathematics Department, Boston, Mass (R.B.D., A.M.B., H.S.); and Framingham Heart Study, Boston University School of Medicine, Framingham, Mass (W.B.K.).

Background—The objective of this study was to examine the association of Joint National Committee (JNC-V) blood pressure and National Cholesterol Education Program (NCEP) cholesterol categories with coronary heart disease (CHD) risk, to incorporate them into coronary prediction algorithms, and to compare the discrimination properties of this approach with other noncategorical prediction functions.

Methods and Results—This work was designed as a prospective, single-center study in the setting of a community-based cohort. The patients were 2489 men and 2856 women 30 to 74 years old at baseline with 12 years of follow-up. During the 12 years of follow-up, a total of 383 men and 227 women developed CHD, which was significantly associated with categories of blood pressure, total cholesterol, LDL cholesterol, and HDL cholesterol (all P<.001). Sex-specific prediction equations were formulated to predict CHD risk according to age, diabetes, smoking, JNC-V blood pressure categories, and NCEP total cholesterol and LDL cholesterol categories. The accuracy of this categorical approach was found to be comparable to CHD prediction when the continuous variables themselves were used. After adjustment for other factors, 28% of CHD events in men and 29% in women were attributable to blood pressure levels that exceeded high normal (130/85). The corresponding multivariable-adjusted attributable risk percent associated with elevated total cholesterol (200 mg/dL) was 27% in men and 34% in women.

Conclusions—Recommended guidelines of blood pressure, total cholesterol, and LDL cholesterol effectively predict CHD risk in a middle-aged white population sample. A simple coronary disease prediction algorithm was developed using categorical variables, which allows physicians to predict multivariate CHD risk in patients without overt CHD.

Key Words: coronary disease • prediction • hypertension • cholesterol

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				S. Ye, J. Willeit, F. Kronenberg, Q. Xu, and S. Kiechl Association of Genetic Variation on Chromosome 9p21 With Susceptibility and Progression of Atherosclerosis: A Population-Based, Prospective Study J. Am. Coll. Cardiol., July 29, 2008; 52(5): 378 - 384. [Abstract] [Full Text] [PDF]

				A. Qasim, N. N. Mehta, M. G. Tadesse, M. L. Wolfe, T. Rhodes, C. Girman, and M. P. Reilly Adipokines, insulin resistance, and coronary artery calcification. J. Am. Coll. Cardiol., July 15, 2008; 52(3): 231 - 236. [Abstract] [Full Text] [PDF]

				Ankle Brachial Index Collaboration Ankle Brachial Index Combined With Framingham Risk Score to Predict Cardiovascular Events and Mortality: A Meta-analysis JAMA, July 9, 2008; 300(2): 197 - 208. [Abstract] [Full Text] [PDF]

				S. K. Grinspoon, C. Grunfeld, D. P. Kotler, J. S. Currier, J. D. Lundgren, M. P. Dube, S. E. Lipshultz, P. Y. Hsue, K. Squires, M. Schambelan, et al. State of the Science Conference: Initiative to Decrease Cardiovascular Risk and Increase Quality of Care for Patients Living With HIV/AIDS: Executive Summary Circulation, July 8, 2008; 118(2): 198 - 210. [Full Text] [PDF]

				J. S. Currier, J. D. Lundgren, A. Carr, D. Klein, C. A. Sabin, P. E. Sax, J. T. Schouten, M. Smieja, and for Working Group 2 Epidemiological Evidence for Cardiovascular Disease in HIV-Infected Patients and Relationship to Highly Active Antiretroviral Therapy Circulation, July 8, 2008; 118(2): e29 - e35. [Full Text] [PDF]

				P. Y. Hsue, K. Squires, A. F. Bolger, B. Capili, G. A. Mensah, Z. Temesgen, C. A. Wanke, D. A. Wohl, and for Working Group 4 Screening and Assessment of Coronary Heart Disease in HIV-Infected Patients Circulation, July 8, 2008; 118(2): e41 - e47. [Full Text] [PDF]

				M. Schambelan, P. W.F. Wilson, K. E. Yarasheski, W. T. Cade, V. G. Davila-Roman, R. B. D'Agostino Sr, T. A. Helmy, M. Law, K. E. Mondy, S. Nachman, et al. Development of Appropriate Coronary Heart Disease Risk Prediction Models in HIV-Infected Patients Circulation, July 8, 2008; 118(2): e48 - e53. [Full Text] [PDF]

				P. W.F. Wilson, S. R. Bozeman, T. M. Burton, D. C. Hoaglin, R. Ben-Joseph, and C. L. Pashos Prediction of First Events of Coronary Heart Disease and Stroke With Consideration of Adiposity Circulation, July 8, 2008; 118(2): 124 - 130. [Abstract] [Full Text] [PDF]