Abstract 1007: Women Up, Men Down: The Clinical Impact of Replacing the Framingham Risk Score With the Reynolds Risk Score in the United States Population
Background The Reynolds Risk Score (RRS) is a proposed alternative to the Framingham Risk Score (FRS) for calculating 10-year coronary heart disease (CHD) risk. In initial trials, 20% of men and 44% of women at intermediate risk changed risk categories from the FRS to the RRS. We analyzed the entire eligible US population comparing both scores in men and women. We further defined the subgroup for whom the new risk category would impact the clinical LDL-C treatment recommendations.
Methods We compared the Framingham and Reynolds risk categories in men age 50 –79 and women age 45–79 without CHD or diabetes, using the National Health and Nutrition Examination Surveys 1999 –2002. For those with differing risk categories, we defined clinical impact as a change in LDL-C goal achievement.
Results Of the 20 Million (M) men, 1.8M (9%) have a Reynolds risk category higher than Framingham, while 7.2M (36%) are lower. Of 34M women, 4.6M (14%) are higher using Reynolds while 0.7M (2%) are lower. Only 0.2M (1%) of men and 1.6M (4.7%) of women who had met LDL-C goal with Framingham, no longer meet their Reynolds defined goal. However, 2.1M (11%) of men and 0.2M (0.6%) of women now meet their Reynolds LDL-C goal.
Discussion Replacing Framingham with Reynolds for CHD risk prediction changes the risk category in just 16% of women, with 14% moving up. More men (45%) change risk categories, with 36% moving down. Clinically, this results in 2.1M (11%) US men newly at LDL-C goal, and conversely, 1.6M (4.7%) US women would no longer meet their LDL-C goal. The decision to replace the FRS with the RRS as the risk assessment standard will have only modest clinical impact and very different implications for men than it does in women.