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Systematic examination of the updated Framingham heart study general cardiovascular risk profile
Amanda K Marma1, Donald M Lloyd-Jones
1Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Dr, Suite 1102, Chicago, IL 60611, USA.
Insights
The updated Framingham risk tool shows age is key, but high risk factors like smoking and diabetes can impact younger individuals. Vascular age communication aids risk understanding.
Area of Science:
- Cardiology
- Preventive Medicine
- Risk Assessment
Background:
- A new Framingham risk prediction tool incorporates general cardiovascular disease endpoints.
- It introduces a "vascular age" concept for risk communication.
Purpose of the Study:
- To analyze risk factor combinations and their impact on cardiovascular risk thresholds.
- To understand how varying risk factor burdens translate into "vascular age".
Main Methods:
- Systematic examination of the updated risk prediction tool.
- Varying individual and combined risk factor levels to observe predicted risk output.
- Defining high risk as a 10-year predicted risk of >=20%.
Main Results:
- Age is the primary determinant of 10-year cardiovascular risk for both sexes.
- Younger individuals with multiple risk factors may still have low predicted risk.
- High risk (>=20%) can occur in men aged 35 and women aged 40 with significant risk factors (smoking, diabetes).
- Predicted 10-year risk ranged from 3.1% to 46.8% for a 45-year-old man and 2.4% to 42.7% for a 55-year-old woman.
- Vascular age varied widely, from 37 to over 80 years for a 45-year-old man and 39 to over 80 years for a 55-year-old woman.
Conclusions:
- The tool's expanded endpoints increase predicted risk ranges across ages.
- Younger individuals with substantial risk factors may present with low 10-year risk.
- The "vascular age" metric offers a broad communication tool for cardiovascular risk across chronological ages.
Background:
An updated Framingham risk prediction tool was recently published. It features an expanded end point of general cardiovascular disease and a "vascular age" risk communication analogy.
Methods And Results:
We systematically examined the tool to determine which risk factor combinations allow risk thresholds to be reached and how different risk factor burdens translate into vascular age. We varied risk factor levels in isolation and combination and observed risk output patterns, with high risk defined as > or =20% 10-year predicted risk. As expected, we found that age is the major determinant of 10-year predicted risk for both men and women. Younger individuals tend not to exceed 20% 10-year risk even with multiple risk factors, although with marked risk factor burden, including both smoking and diabetes mellitus, men as young as 35 years of age and women as young as 40 years of age can be classified as high risk. For the risk factor levels we entered, predicted risk ranges from 3.1% to 46.8% for a 45-year-old man and 2.4% to 42.7% for a 55-year-old woman. Likewise, vascular age ranges from 37 to >80 years for a 45-year-old man and 39 to >80 years for a 55-year-old woman.
Conclusions:
The inclusion of noncoronary end points in this tool expands the range of predicted risks for men and women at all ages studied. Nevertheless, many younger individuals with high risk factor burden have low 10-year predicted risk. Wide ranges of "vascular age" are available for most chronological ages to assist with risk communication.
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