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[How I explore...the absolute cardiovascular risk at 10 years: from Framingham 1998 to SCORE 2003]
1Université de Liège, Service de Diabétologie, Nutrition et Maladies métaboliques, Département de Médecine, CHU Sart Tilman.
Insights
Identifying high-risk individuals for cardiovascular disease prevention is crucial. This study compares the Framingham equation and the SCORE model for calculating atherosclerosis risk, aiding clinical intervention decisions.
Area of Science:
- Cardiology
- Preventive Medicine
- Risk Assessment
Background:
- Cardiovascular disease (CVD) prevention strategies target high-risk individuals.
- Risk assessment is essential for identifying individuals needing intervention.
- Atherosclerosis risk factors are key determinants in risk calculation.
Purpose of the Study:
- To compare the Framingham equation and the SCORE model for cardiovascular risk assessment.
- To evaluate the advantages and disadvantages of each risk calculation method.
- To inform clinical practice regarding the selection of appropriate risk assessment tools.
Main Methods:
- Analysis of the Framingham equation for coronary risk (morbidity and mortality) over 10 years.
- Analysis of the SCORE model for cardiovascular mortality risk over 10 years.
- Comparative evaluation of risk thresholds and calculation methodologies.
Main Results:
- The Framingham equation defines high risk as ≥20% 10-year coronary risk.
- The SCORE model defines high risk as ≥5% 10-year cardiovascular mortality risk.
- Differences in scope (coronary vs. cardiovascular) and outcomes (morbidity/mortality vs. mortality) exist between the models.
Conclusions:
- Both Framingham and SCORE models aid in identifying high-risk individuals for CVD prevention.
- The choice of model depends on the specific clinical context and desired outcome assessment.
- Understanding the nuances of each model is vital for effective risk stratification and intervention.
Abstract:
Prevention of cardiovascular diseases should primarily focus on high-risk individuals. In the absence of atherosclerosis manifestations, such persons may be screened by the calculation of the absolute risk of complications during the next ten years or extrapolated at the age of 60 years. This calculation is based upon the analysis of most important risk factors of atherosclerosis. The mode of calculation that prevailed for many years used the Framingham equation determining the absolute coronary risk (both morbidity and mortality) in the next 10 years: a risk equal or superior to 20% is considered as high and requiring specific intervention. The Third Joint Task Force of European and other Societies on cardiovascular disease prevention in clinical practice recently proposed a new mode of calculation (SCORE) based upon the absolute risk of cardiovascular (and not exclusively coronary) mortality (only fatal events and not morbidity): according to SCORE, the threshold of high risk has been set at a risk equal or superior to 5% in the next 10 years. The present article compares the two modes of calculation with their own advantages and disadvantages.
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