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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, {approx}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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BMJ, January 14, 2010; 340(jan14_1): b4838 - b4838.
[Abstract] [Full Text] [PDF]


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Circ. Res.Home page
I. Tabas, A. Tall, and D. Accili
The Impact of Macrophage Insulin Resistance on Advanced Atherosclerotic Plaque Progression
Circ. Res., January 8, 2010; 106(1): 58 - 67.
[Abstract] [Full Text] [PDF]


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Arch NeurolHome page
M. Thambisetty, L. Beason-Held, Y. An, M. A. Kraut, and S. M. Resnick
APOE {varepsilon}4 Genotype and Longitudinal Changes in Cerebral Blood Flow in Normal Aging
Arch Neurol, January 1, 2010; 67(1): 93 - 98.
[Abstract] [Full Text] [PDF]


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Am. J. Respir. Crit. Care Med.Home page
J. Z. Metcalfe, A. Cattamanchi, E. Vittinghoff, C. Ho, J. Grinsdale, P. C. Hopewell, L. M. Kawamura, and P. Nahid
Evaluation of Quantitative IFN-{gamma} Response for Risk Stratification of Active Tuberculosis Suspects
Am. J. Respir. Crit. Care Med., January 1, 2010; 181(1): 87 - 93.
[Abstract] [Full Text] [PDF]


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CJASNHome page
M. Z. Molnar, A. S. Lazar, A. Lindner, K. Fornadi, M. E. Czira, A. Dunai, R. Zoller, A. Szentkiralyi, L. Rosivall, C. M. Shapiro, et al.
Sleep Apnea Is Associated with Cardiovascular Risk Factors among Kidney Transplant Patients
Clin. J. Am. Soc. Nephrol., January 1, 2010; 5(1): 125 - 132.
[Abstract] [Full Text] [PDF]


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Clin. Chem.Home page
K. Sydow, S. P. Fortmann, J. M. Fair, A. Varady, M. A. Hlatky, A. S. Go, C. Iribarren, P. S. Tsao, and for the ADVANCE Investigators
Distribution of Asymmetric Dimethylarginine among 980 Healthy, Older Adults of Different Ethnicities
Clin. Chem., January 1, 2010; 56(1): 111 - 120.
[Abstract] [Full Text] [PDF]


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Ann Rheum DisHome page
H G Raterman, I C van Eijk, A E Voskuyl, M J L Peters, B A C Dijkmans, V P van Halm, S Simsek, W F Lems, and M T Nurmohamed
The metabolic syndrome is amplified in hypothyroid rheumatoid arthritis patients: a cross-sectional study
Ann Rheum Dis, January 1, 2010; 69(01): 39 - 42.
[Abstract] [Full Text] [PDF]


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RadioGraphicsHome page
T. Ayer, J. Chhatwal, O. Alagoz, C. E. Kahn Jr, R. W. Woods, and E. S. Burnside
Informatics in Radiology: Comparison of Logistic Regression and Artificial Neural Network Models in Breast Cancer Risk Estimation
RadioGraphics, January 1, 2010; 30(1): 13 - 22.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
E. Y. Yang, V. Nambi, Z. Tang, S. S. Virani, E. Boerwinkle, R. C. Hoogeveen, B. C. Astor, T. H. Mosley, J. Coresh, L. Chambless, et al.
Clinical Implications of JUPITER (Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) in a U.S. Population Insights From the ARIC (Atherosclerosis Risk in Communities) Study.
J. Am. Coll. Cardiol., December 15, 2009; 54(25): 2388 - 2395.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
J. A. Ladapo, F. A. Jaffer, U. Hoffmann, C. C. Thomson, F. Bamberg, W. Dec, D. M. Cutler, M. C. Weinstein, and G. S. Gazelle
Clinical outcomes and cost-effectiveness of coronary computed tomography angiography in the evaluation of patients with chest pain.
J. Am. Coll. Cardiol., December 15, 2009; 54(25): 2409 - 2422.
[Abstract] [Full Text] [PDF]


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CirculationHome page
M. McGeachie, R. L. B. Ramoni, J. C. Mychaleckyj, K. L. Furie, J. M. Dreyfuss, Y. Liu, D. Herrington, X. Guo, J. A. Lima, W. Post, et al.
Integrative Predictive Model of Coronary Artery Calcification in Atherosclerosis
Circulation, December 15, 2009; 120(24): 2448 - 2454.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
R. L. Sacco, M. Khatri, T. Rundek, Q. Xu, H. Gardener, B. Boden-Albala, M. R. Di Tullio, S. Homma, M. S.V. Elkind, and M. C. Paik
Improving Global Vascular Risk Prediction With Behavioral and Anthropometric Factors The Multiethnic NOMAS (Northern Manhattan Cohort Study).
J. Am. Coll. Cardiol., December 8, 2009; 54(24): 2303 - 2311.
[Abstract] [Full Text] [PDF]


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JAMAHome page
I. Tzoulaki, G. Liberopoulos, and J. P. A. Ioannidis
Assessment of Claims of Improved Prediction Beyond the Framingham Risk Score
JAMA, December 2, 2009; 302(21): 2345 - 2352.
[Abstract] [Full Text] [PDF]


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JAMAHome page
P. W. F. Wilson
Challenges to Improve Coronary Heart Disease Risk Assessment
JAMA, December 2, 2009; 302(21): 2369 - 2370.
[Full Text] [PDF]


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ANGIOLOGYHome page
F. Saab, D. Mukherjee, H. Gurm, A. Motivala, D. Montgomery, E. Kline-Rogers, M. Rubenfire, and K. Eagle
Risk Factors in First Presentation Acute Coronary Syndromes (ACS): How Do We Move From Population to Individualized Risk Prediction?
Angiology, December 1, 2009; 60(6): 663 - 667.
[Abstract] [PDF]


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Circ Cardiovasc GenetHome page
S. Su, J. Zhao, J. D. Bremner, A. H. Miller, W. Tang, M. Bouzyk, H. Snieder, O. Novik, N. Afzal, J. Goldberg, et al.
Serotonin Transporter Gene, Depressive Symptoms, and Interleukin-6
Circ Cardiovasc Genet, December 1, 2009; 2(6): 614 - 620.
[Abstract] [Full Text] [PDF]


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Clin. Chem.Home page
K. Ketlogetswe and R. S. Blumenthal
Thirty-Year Multivariate Risk Assessment Is a Stronger Predictor of Cardiovascular Disease than the 10-Year Model
Clin. Chem., December 1, 2009; 55(12): 2085 - 2087.
[Full Text] [PDF]


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Arch Intern MedHome page
J. Ma, K. Berra, W. L. Haskell, L. Klieman, S. Hyde, M. W. Smith, L. Xiao, and R. S. Stafford
Case Management to Reduce Risk of Cardiovascular Disease in a County Health Care System
Arch Intern Med, November 23, 2009; 169(21): 1988 - 1995.
[Abstract] [Full Text] [PDF]


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Am J EpidemiolHome page
K. Steenland, S. Tinker, S. Frisbee, A. Ducatman, and V. Vaccarino
Association of Perfluorooctanoic Acid and Perfluorooctane Sulfonate With Serum Lipids Among Adults Living Near a Chemical Plant
Am. J. Epidemiol., November 15, 2009; 170(10): 1268 - 1278.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
S. M. Chang, F. Nabi, J. Xu, L. E. Peterson, A. Achari, C. M. Pratt, and J. J. Mahmarian
The coronary artery calcium score and stress myocardial perfusion imaging provide independent and complementary prediction of cardiac risk.
J. Am. Coll. Cardiol., November 10, 2009; 54(20): 1872 - 1882.
[Abstract] [Full Text] [PDF]


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JCOHome page
A. B. Chen, R. S. Punglia, K. M. Kuntz, P. M. Mauch, and A. K. Ng
Cost Effectiveness and Screening Interval of Lipid Screening in Hodgkin's Lymphoma Survivors
J. Clin. Oncol., November 10, 2009; 27(32): 5383 - 5389.
[Abstract] [Full Text] [PDF]


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ICVTSHome page
P. Stolzmann, C. Phan, L. Desbiolles, M. Lachat, T. Pfammatter, B. Marincek, M. Prokop, and H. Alkadhi
The heart of patients with aortic aneurysms: evidence from cardiac computed tomography
Interactive CardioVascular and Thoracic Surgery, November 1, 2009; 9(5): 769 - 773.
[Abstract] [Full Text] [PDF]


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J Am Coll Cardiol ImgHome page
S. J. Lehman, C. L. Schlett, F. Bamberg, H. Lee, P. Donnelly, L. Shturman, M. F. Kriegel, T. J. Brady, and U. Hoffmann
Assessment of Coronary Plaque Progression in Coronary Computed Tomography Angiography Using a Semiquantitative Score
J. Am. Coll. Cardiol. Img., November 1, 2009; 2(11): 1262 - 1270.
[Abstract] [Full Text] [PDF]


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Occup. Environ. Med.Home page
E. Suarthana, E. Meijer, D. E Grobbee, and D. Heederik
Predicting occupational diseases
Occup. Environ. Med., November 1, 2009; 66(11): 713 - 714.
[Full Text] [PDF]