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. 2013 Mar;8(1):11-23.
doi: 10.1016/j.gheart.2013.01.001.

Cardiovascular Disease Risk Assessment: Insights from Framingham

Ralph B D'Agostino Sr  1 , Michael J Pencina, Joseph M Massaro, Sean Coady
Affiliations

Cardiovascular Disease Risk Assessment: Insights from Framingham

Ralph B D'Agostino Sr et al. Glob Heart. 2013 Mar.

Abstract

Cardiovascular disease (CVD) is among the leading causes of death and disability worldwide. Since its beginning, the Framingham study has been a leader in identifying CVD risk factors. Clinical trials have demonstrated that when the modifiable risk factors are treated and corrected, the chances of CVD occurring can be reduced. The Framingham study also recognized that CVD risk factors are multifactorial and interact over time to produce CVD. In response, Framingham investigators developed the Framingham Risk Functions (also called Framingham Risk Scores) to evaluate the chance or likelihood of developing CVD in individuals. These functions are multivariate functions (algorithms) that combine the information in CVD risk factors such as sex, age, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, smoking behavior, and diabetes status to produce an estimate (or risk) of developing CVD or a component of CVD (such as coronary heart disease, stroke, peripheral vascular disease, or heart failure) over a fixed time, for example, the next 10 years. These estimates of CVD risk are often major inputs in recommending drug treatments such as cholesterol-lowering drugs.

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Figures

FIGURE 1
FIGURE 1
Risk of CHD according to elevated blood pressure (BP), elevated cholesterol, and left ventricular hypertrophy: Framingham cohort 6-year follow-up. Elevated BP = ≥160/95; elevated cholesterol = ≥260 mg/dl
FIGURE 2
FIGURE 2
Cox model: (A) mathematical model; (B) general structure of Cox model survival to time t.
FIGURE 3
FIGURE 3
Receiver-operating characteristic curve for prediction of coronary heart disease: Framingham men.
FIGURE 4
FIGURE 4
Calibration plot showing mean risk calibrated by decile.
FIGURE 5
FIGURE 5
Calibration adjustment for transportation to a different population. See Harrell et al. [37].
FIGURE 6
FIGURE 6
C-statistics for women in the Chinese Multi-Provincial Cohort Study (CMCS) and Framingham Heart Study (FHS).
FIGURE 7
FIGURE 7
Chi-square calibration for women in the Chinese Multi-Provincial Cohort Study (CMCS) and Framingham Heart Study (FHS)
See this image and copyright information in PMC

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