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(Circulation. 2005;111:657-658.)
© 2005 American Heart Association, Inc.

Special Report

Should Age and Time Be Eliminated From Cardiovascular Risk Prediction Models?

Rationale for the Creation of a New National Risk Detection Program

Paul M Ridker, MD, MPH; Nancy Cook, ScD

From the Center for Cardiovascular Disease Prevention, Brigham and Women’s Hospital, Harvard Medical School.

Correspondence to Dr Paul M Ridker, Center for Cardiovascular Disease Prevention, Brigham and Women’s Hospital, 900 Commonwealth Ave E, Boston, MA 02215. E-mail pridker@partners.org

Key Words: cardiovascular diseases • risk factors • prevention • risk assessment

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A primary goal of coronary prediction models is to identify high-risk individuals who will benefit from aggressive lifestyle changes such as dietary prudence, smoking cessation, and regular exercise. In prediction algorithms like those derived from the Framingham Heart Study,^1,2 however, risk calculation is highly dependent on aging and is presented to patients as an anticipated risk over the coming 10 years. Patients with calculated 10-year Framingham risk scores (FRS) <10% are considered to be at lower risk for vascular events during the next decade, whereas patients with scores between 10% and 20% are at moderate risk and those >20% are at higher risk.

See p 542

Although epidemiologically sound, this approach to risk classification has limitations in clinical practice. Consider a 30-year-old woman who is overweight, rarely exercises, smokes 2 packs of cigarettes daily, has stage II hypertension (systolic blood pressure >160 mm Hg) and severe hyperlipidemia (LDL cholesterol of 190 mg/dL and HDL cholesterol of 35 mg/dL). All physicians would recognize that this individual has very high lifetime vascular risk and would benefit greatly from immediate lifestyle interventions.

Clinical application of the FRS typically does not, however, involve a calculation of lifetime risk but focuses instead on 10-year risk. Using the original Framingham Risk tables based on LDL and HDL cholesterol measures,¹ the calculated FRS for this patient is zero, conferring a 10-year risk of coronary heart disease of 2%, a very low risk category (Table 1, left). If no preventive effort is initiated and her current . . . [Full Text of this Article]

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