Assign a 10-year risk score. Patients are considered to be at elevated risk if the 10-year risk score is ≥7.5%. When to USE the calculator: ∆ Patients 40 to 79 years of age without ASCVD ∆ Patients with LDL levels 70 to 189 mg/dL without ASCVD and not on statin therapy When NOT to use the calculator.
Contents. Cardiovascular Risk Scoring systems The Framingham Risk Score is one of a number of scoring systems used to determine an individual's chances of developing cardiovascular disease.
A number of these scoring systems are available online. Cardiovascular risk scoring systems give an estimate of the probability that a person will develop cardiovascular disease within a specified amount of time, usually 10 to 30 years. Because they give an indication of the risk of developing cardiovascular disease, they also indicate who is most likely to benefit from prevention. For this reason, cardiovascular risk scores are used to determine who should be offered preventive drugs such as drugs to lower blood pressure and drugs to lower cholesterol levels. For example, nearly 30% of coronary heart disease (CHD) events in both men and women were singularly attributable to blood pressure levels that exceeded high normal (≥130/85), showing that blood pressure management and monitoring is paramount both to cardiovascular health and prediction of outcomes. Usefulness Because risk scores such as the Framingham Risk Score give an indication of the likely benefits of prevention, they are useful for both the individual patient and for the clinician in helping decide whether lifestyle modification and preventive medical treatment, and for patient education, by identifying men and women at increased risk for future cardiovascular events. (CHD) risk at 10 years in percent can be calculated with the help of the Framingham Risk Score.
Individuals with low risk have 10% or less CHD risk at 10 years, with intermediate risk 10-20%, and with high risk 20% or more. However it should be remembered that these categorisations are arbitrary. A more useful metric is to consider the effects of treatment.
If a group of 100 persons all have a 20% ten-year risk of cardiovascular disease it means that we should expect that 20 of these 100 individuals will develop cardiovascular disease (coronary heart disease or stroke) in the next 10 years and eighty of them will not develop cardiovascular disease in the next 10 years. If they were to take a combination of treatments (for example drugs to lower cholesterol levels plus drugs to lower blood pressure) that reduced their risk of cardiovascular disease by half it means that 10 of these 100 individuals should be expected to develop cardiovascular disease in the next 10 years and 90 of them should not be expected to develop cardiovascular disease. If that was the case then 10 of these individuals would have avoided cardiovascular disease by taking treatment for 10 years; 10 would get cardiovascular disease whether or not they took treatment; and 80 would not have got cardiovascular disease whether or not they took treatment. Despite their widespread popularity, randomised trials assessing the impact of using cardiovascular disease risk scores show limited impact on patient outcomes.
Although there is good evidence that targeting individuals with high total CVD risk is the most efficient way to reduce CVD-related morbidity and mortality, to date trials assessing the usefulness of risk scores at helping clinicians target high risk patients show limited benefit. Issues Raised by Cardiovascular Risk Prediction It is important to recognize that the strongest predictor of cardiovascular risk in any risk equation is age. Almost all persons aged 70 and over are at 20% ten year cardiovascular risk and almost nobody aged under 40 is at 20% ten year cardiovascular risk.
Since those who benefit most from treatment are those at highest risk, this means that treatment of patients with raised blood pressure and raised cholesterol levels in their thirties benefits very few. Whereas treatment of patients with 'normal' blood pressure and 'normal' cholesterol levels in their seventies benefits many. This casts doubt on the wisdom of categorizing individuals as having high blood pressure or raised cholesterol and treating these individual risk factors without a consideration of both their overall risk of cardiovascular disease and of the probability that they will benefit. Background is common in the general population, affecting the majority of adults. It includes: 1) (CHD): (MI), (HF), and.
2), and (TIA). 3), and significant limb. 4) Aortic disease: Aortic, and. An individual’s risk for future cardiovascular events is modifiable, by lifestyle changes and preventive medical treatment. Lifestyle changes can include stopping, regular, etc. Preventive medical treatment can include a, mini dose, treatment for, etc.
It is important to be able to predict the risk of an individual patient, in order to decide when to initiate lifestyle modification and preventive medical treatment. Multiple risk models for the prediction of cardiovascular risk of individual patients have been developed. One such key is the Framingham Risk Score. The Framingham Risk Score is based on findings from the. Validation The Framingham Risk Score has been validated in the USA, both in men and women, both in European Americans and African Americans.
While several studies have claimed to improve on the FRS, there is little evidence for any improved prediction beyond the Framingham risk score Limitations There are two limitations. The Framingham Risk Score predicts only future coronary heart disease (CHD) events, however, it does not predict future total cardiovascular events, meaning that it does not predict risk for stroke, transient ischemic attack (TIA), and heart failure.
These also important patient outcomes were included in the 2008 Framingham General Cardiovascular Risk Score. The predicted risk for an individual usually is higher with the 2008 Framingham General Cardiovascular Risk Score than with the 2002 Framingham Risk Score.
The Framingham Risk Score could overestimate (or underestimate) risk in populations other than the US population, and within the USA in populations other than European Americans and African Americans, e.g. Hispanic Americans and Native Americans. It is not yet clear if this limitation is real, or appears to be real because of differences in methodology, etc. As a result, other countries may prefer to use another risk score, e.g. (HeartScore is the interactive version of SCORE - Systematic COronary Risk Evaluation), which has been recommended by the in 2007.
If possible, a professional should select the risk prediction model which is most appropriate for an individual patient and should remember that this is only an estimate. Versions The current version of the Framingham Risk Score was published in 2008. The publishing body is the ATP III, i.e. The «Adult Treatment Panel III», an expert panel of the, which is part of the (NIH), USA.
The prior version was published in 2002 The original Framingham Risk Score had been published in 1998. Differences between the versions The first Framingham Risk Score included age, sex, LDL cholesterol, HDL cholesterol, blood pressure (and also whether the patient is treated or not for his/her hypertension), diabetes, and smoking. It estimated the 10-year risk for coronary heart disease (CHD). It performed well, and correctly predicted 10-year risk for CHD in American men and women of European and African descent. The updated version was modified to include, age range, hypertension treatment, smoking, and total cholesterol, and it excluded, because Type 2 diabetes meanwhile was considered to be a CHD Risk Equivalent, having the same 10-year risk as individuals with prior CHD.
Patients with Type 1 diabetes were considered separately with slightly less aggressive goals; while at increased risk, no study had shown them to be at equivalent risk for CHD as those with previously diagnosed coronary disease or Type 2 diabetes. CHD Risk Equivalent Some patients without known CHD have risk of cardiovascular events that is comparable to that of patients with established CHD. Cardiology professionals refer to such patients as having a CHD risk equivalent.
These patients should be managed as patients with known CHD. CHD risk equivalents are patients with a 10-year risk for or 20%. CHD risk equivalents are primarily other clinical forms of atherosclerotic disease. The NCEP's ATP III guidelines also list diabetes as a CHD risk equivalent since it also has a 10-year risk for CHD around 20%. NCEP ATP III CHD risk equivalents are:. clinical (CHD). symptomatic (CAD).
(PAD). (AAA). Analysis of the US population with the Framingham/ATP III criteria The Framingham/ATP III criteria were used to estimate CHD risk in the USA. Data from 11,611 patients from a very large study, the III, were used. The patients were 20 to 79 years of age, and had no self reported CHD, stroke, peripheral arterial disease, or diabetes. The results: 82% of patients had low risk (10% or less CHD risk at 10 years). 16% had intermediate risk (10-20%).
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3% had high risk (20% or more). High risk was most commonly found in patients with advanced age, and was more common in men than women. High risk patients are sometimes become unknown with certain signs and symptoms of cardiac failure Scoring Framingham Risk Score for Women Age: 20–34 years: Minus 7 points. 35–39 years: Minus 3 points. 40–44 years: 0 points. 45–49 years: 3 points.
50–54 years: 6 points. 55–59 years: 8 points. 60–64 years: 10 points. 65–69 years: 12 points. 70–74 years: 14 points. 75–79 years: 16 points. Total cholesterol, mg/dL: Age 20–39 years: Under 160: 0 points.
160-199: 4 points. 200-239: 8 points. 240-279: 11 points. 280 or higher: 13 points.
Age 40–49 years: Under 160: 0 points. 160-199: 3 points.
200-239: 6 points. 240-279: 8 points. 280 or higher: 10 points. Age 50–59 years: Under 160: 0 points. 160-199: 2 points. 200-239: 4 points. 240-279: 5 points.
280 or higher: 7 points. Age 60–69 years: Under 160: 0 points. 160-199: 1 point. 200-239: 2 points. 240-279: 3 points. 280 or higher: 4 points. Age 70–79 years: Under 160: 0 points.
160-199: 1 point. 200-239: 1 point.
240-279: 2 points. 280 or higher: 2 points. If cigarette smoker: Age 20–39 years: 9 points. Age 40–49 years: 7 points. Age 50–59 years: 4 points. Age 60–69 years: 2 points. Age 70–79 years: 1 point.
All non smokers: 0 points. HDL cholesterol, mg/dL: 60 or higher: Minus 1 point. 50-59: 0 points. 40-49: 1 point.
Under 40: 2 points. Systolic blood pressure, mm Hg: Untreated: Under 120: 0 points. 120-129: 1 point. 130-139: 2 points. 140-159: 3 points. 160 or higher: 4 points. Treated: Under 120: 0 points.
120-129: 3 points. 130-139: 4 points. 140-159: 5 points.
160 or higher: 6 points. 10-year risk in%: Points total: Under 9 points: 25= Over 30% Framingham Risk Score for Men Age: 20–34 years: Minus 9 points. 35–39 years: Minus 4 points. 40–44 years: 0 points. 45–49 years: 3 points.
Framingham Risk Score Sheet
50–54 years: 6 points. 55–59 years: 8 points. 60–64 years: 10 points. 65–69 years: 11 points. 70–74 years: 12 points. 75–79 years: 13 points.
Total cholesterol, mg/dL: Age 20–39 years: Under 160: 0 points. 160-199: 4 points. 200-239: 7 points.
240-279: 9 points. 280 or higher: 11 points. Age 40–49 years: Under 160: 0 points. 160-199: 3 points. 200-239: 5 points.
Framingham Risk Score Sheet Printable
240-279: 6 points. 280 or higher: 8 points. Age 50–59 years: Under 160: 0 points. 160-199: 2 points. 200-239: 3 points.
240-279: 4 points. 280 or higher: 5 points. Age 60–69 years: Under 160: 0 points.
160-199: 1 point. 200-239: 1 point. 240-279: 2 points.
280 or higher: 3 points. Age 70–79 years: Under 160: 0 points. 160-199: 0 points.
200-239: 0 points. 240-279: 1 point. 280 or higher: 1 point. If cigarette smoker: Age 20–39 years: 8 points.
Age 40–49 years: 5 points. Age 50–59 years: 3 points. Age 60–69 years: 1 point. Age 70–79 years: 1 point.
All non smokers: 0 points. HDL cholesterol, mg/dL: 60 or higher: Minus 1 point.
50-59: 0 points. 40-49: 1 point. Under 40: 2 points.
Systolic blood pressure, mm Hg: Untreated: Under 120: 0 points. 120-129: 0 points. 130-139: 1 point.
Framingham Risk Calculator Pda
140-159: 1 point. 160 or higher: 2 points. Treated: Under 120: 0 points.
120-129: 1 point. 130-139: 2 points.
140-159: 2 points. 160 or higher: 3 points. 10-year risk in%: Points total: 0 point. P.W., Wilson; D'Agostino, R.B.; Levy, D.; Belanger, A.M.; Silbershatz, H.; Kannel, W.B.
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