The Framingham Heart Study's impact on global risk assessment
The present overview provides historical insights into the development of the original and subsequent Framingham risk scores, other risk algorithms that have been developed and utilized in different population settings to predict an individual's risk of CHD and CVD, and the use of these risk schemas to modify one's risk of these adverse outcomes...
Title: The Framingham Heart Study's impact on global risk assessment
Authors: A Bitton, T Gaziano
Reference: Prog Cardiovasc Dis 2010; 53:68-78 (Open access on ProCor)
http://www.procor.org/news/news_show.htm?doc_id=1305731
Reviewer: Robert Goldberg, PhD, Contributing editor, ProCor; Professor of Medicine and Epidemiology, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
Reviewer comments: Despite ongoing declines in the death rates attributed to coronary heart disease (CHD) in the US during the past 40 years, CHD remains a major cause of morbidity, mortality, and functional disability in Americans and in men and women throughout the world. In 2005, approximately 17 million Americans were estimated to have had CHD diagnosed and nearly 450,000 adult men and women died from this chronic disease. Reinforcing the magnitude of CHD in middle-aged and elderly Americans, it has been estimated that approximately one-half of adult men and one-third of adult women will develop CHD during their lifetime.
A multiplicity of factors are involved in the development of the early and later stages of coronary atherosclerosis from the appearance of fatty streaks during the first two decades of life to the formation of fibrous plaques, complicated and raised lesions, and development of the clinical manifestations of CHD, mostly during the sixth, seventh, and later decades of life. These risk factors include both modifiable predisposing factors (e.g., diet, physical inactivity) and non-modifiable risk markers (e.g., advanced age, male sex). Newly emerging risk factors for CHD include markers of inflammation, plaque instability, and certain non-modifiable genotypes. Socioeconomic factors, such as low educational attainment and low income, have long been known to be associated with the risk of coronary disease and several recent studies have begun to explore the associations between environmental characteristics with the risk of developing and/or dying from CHD.
These factors, taken individually and in combination, have been used to predict an apparently healthy individual's risk for developing CHD or CVD over varying time periods with the most commonly utilized of these schemas being the predictive models developed from the seminal Framingham Heart Study. The most recent iteration of this scoring system, which calculates an individual's long-term (10 year) risk of developing or dying from CHD, is based on a man or woman's age, sex, and several modifiable risk factors. Based on the Framingham risk score, individuals can be stratified into three levels of risk including low (less than 10%), intermediate (10%-20%), or high (more than 20%) in whom various preventive and treatment strategies might be employed and evaluated.
The present overview provides historical insights into the development of the original and subsequent Framingham risk scores, other risk algorithms that have been developed and utilized in different population settings to predict an individual's risk of CHD and CVD, and the use of these risk schemas to modify one's risk of these adverse outcomes. This is an important publication which should be of use to health care practitioners in both developed and developing countries and to persons interested in designing individual and more broad based primary prevention approaches to modify middle-aged and elderly men and women's risk for CHD and CVD.
Purpose of study: To provide an overview of the development and impact of the Framingham risk prediction algorithm on the creation of other risk prediction scores and on the identification of persons at increased risk for CHD and CVD in developed and developing countries.
Location of study: Boston, MA Study design: Historical overview
Results: This nicely written article begins with an overview of the Framingham Heart Study and discussion of the seminal article written by Dr. Kannel and colleagues in 1961 which introduced the concept of "factors of risk" for CHD and stroke based on the analysis of the first decade's worth of data from the Framingham Heart Study.
After this landmark publication, and introduction to both the lay and professional vernacular of the concept of risk factors, the Framingham investigators developed and refined several risk equations for the prediction of CHD, stroke, and overall fatal and nonfatal CVD events using more sophisticated modeling approaches and more extended follow-up data. These more contemporary risk schemas have not only led to the improved screening for individuals at risk for these untoward events but have also served as the basis for many guidelines that were developed for purposes of identifying, counseling, and treating persons at increased risk for various CVD events.
Based in part on the ability to identify men and women at increased risk for CVD, and increasing availability and use of effective nonpharmacologic and pharmacologic treatment regimens, a number of additional risk scores have been created using data from other US and European studies. These risk scores have included PROCAM, SCORE, CUORE, ASSIGN, QRISK, the Reynolds risk score, and the non-laboratory based NHEFS algorithm which could be of particular use in resource poor countries. The countries that these risk schemas were developed in include the US, Germany and several European countries, Scotland, and the UK. While these risk schemas have been shown to be relatively robust, and have lent additional rigor to the science of risk assessment tools and enhanced risk prediction, the validity and generalizability of these risk scores outside of the populations or areas from which they were originally developed remains limited. Despite the reasonable predictive utilities of these risk scores, the development of risk algorithms in developing countries remains sorely needed. Moreover, risk prediction schemas also need to be developed using the development of the risk factors themselves as endpoints and identification of factors, especially in adolescents and young adults that place these individuals at increased risk for developing the major risk factors for CHD including cigarette smoking, hyperlipidemia, elevated blood pressure, physical inactivity, and less than optimal body weight.
The authors provide a nice overview of the risk factors included in these different risk assessment scores and their estimates of internal and external validity (e.g., generalizability) using different analytic approaches. This portion of the article should be of particular interest to researchers in the field and practicing clinicians as the characteristics of the respective study populations, factors included in each of these risk algorithms, and the endpoints examined are clearly laid out. Areas under the curve for each of these risk scores were calculated which provides insights to the utility of each of these risk scores, estimation of actual risk, as well as a discussion of their ease of administration.
Finally, the article concludes by summarizing the implications for policymaking of the eight risk scores examined and their potential use in developing countries for identifying men and women at increased risk for CVD in whom increased surveillance efforts and use of different preventive and treatment approaches can be more effectively targeted and utilized.
Title: The Framingham Heart Study's impact on global risk assessment
Authors: A Bitton, T Gaziano
Reference: Prog Cardiovasc Dis 2010; 53:68-78 (Open access on ProCor)
http://www.procor.org/news/news_show.htm?doc_id=1305731
Reviewer: Robert Goldberg, PhD, Contributing editor, ProCor; Professor of Medicine and Epidemiology, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
Reviewer comments: Despite ongoing declines in the death rates attributed to coronary heart disease (CHD) in the US during the past 40 years, CHD remains a major cause of morbidity, mortality, and functional disability in Americans and in men and women throughout the world. In 2005, approximately 17 million Americans were estimated to have had CHD diagnosed and nearly 450,000 adult men and women died from this chronic disease. Reinforcing the magnitude of CHD in middle-aged and elderly Americans, it has been estimated that approximately one-half of adult men and one-third of adult women will develop CHD during their lifetime.
A multiplicity of factors are involved in the development of the early and later stages of coronary atherosclerosis from the appearance of fatty streaks during the first two decades of life to the formation of fibrous plaques, complicated and raised lesions, and development of the clinical manifestations of CHD, mostly during the sixth, seventh, and later decades of life. These risk factors include both modifiable predisposing factors (e.g., diet, physical inactivity) and non-modifiable risk markers (e.g., advanced age, male sex). Newly emerging risk factors for CHD include markers of inflammation, plaque instability, and certain non-modifiable genotypes. Socioeconomic factors, such as low educational attainment and low income, have long been known to be associated with the risk of coronary disease and several recent studies have begun to explore the associations between environmental characteristics with the risk of developing and/or dying from CHD.
These factors, taken individually and in combination, have been used to predict an apparently healthy individual's risk for developing CHD or CVD over varying time periods with the most commonly utilized of these schemas being the predictive models developed from the seminal Framingham Heart Study. The most recent iteration of this scoring system, which calculates an individual's long-term (10 year) risk of developing or dying from CHD, is based on a man or woman's age, sex, and several modifiable risk factors. Based on the Framingham risk score, individuals can be stratified into three levels of risk including low (less than 10%), intermediate (10%-20%), or high (more than 20%) in whom various preventive and treatment strategies might be employed and evaluated.
The present overview provides historical insights into the development of the original and subsequent Framingham risk scores, other risk algorithms that have been developed and utilized in different population settings to predict an individual's risk of CHD and CVD, and the use of these risk schemas to modify one's risk of these adverse outcomes. This is an important publication which should be of use to health care practitioners in both developed and developing countries and to persons interested in designing individual and more broad based primary prevention approaches to modify middle-aged and elderly men and women's risk for CHD and CVD.
Purpose of study: To provide an overview of the development and impact of the Framingham risk prediction algorithm on the creation of other risk prediction scores and on the identification of persons at increased risk for CHD and CVD in developed and developing countries.
Location of study: Boston, MA Study design: Historical overview
Results: This nicely written article begins with an overview of the Framingham Heart Study and discussion of the seminal article written by Dr. Kannel and colleagues in 1961 which introduced the concept of "factors of risk" for CHD and stroke based on the analysis of the first decade's worth of data from the Framingham Heart Study.
After this landmark publication, and introduction to both the lay and professional vernacular of the concept of risk factors, the Framingham investigators developed and refined several risk equations for the prediction of CHD, stroke, and overall fatal and nonfatal CVD events using more sophisticated modeling approaches and more extended follow-up data. These more contemporary risk schemas have not only led to the improved screening for individuals at risk for these untoward events but have also served as the basis for many guidelines that were developed for purposes of identifying, counseling, and treating persons at increased risk for various CVD events.
Based in part on the ability to identify men and women at increased risk for CVD, and increasing availability and use of effective nonpharmacologic and pharmacologic treatment regimens, a number of additional risk scores have been created using data from other US and European studies. These risk scores have included PROCAM, SCORE, CUORE, ASSIGN, QRISK, the Reynolds risk score, and the non-laboratory based NHEFS algorithm which could be of particular use in resource poor countries. The countries that these risk schemas were developed in include the US, Germany and several European countries, Scotland, and the UK. While these risk schemas have been shown to be relatively robust, and have lent additional rigor to the science of risk assessment tools and enhanced risk prediction, the validity and generalizability of these risk scores outside of the populations or areas from which they were originally developed remains limited. Despite the reasonable predictive utilities of these risk scores, the development of risk algorithms in developing countries remains sorely needed. Moreover, risk prediction schemas also need to be developed using the development of the risk factors themselves as endpoints and identification of factors, especially in adolescents and young adults that place these individuals at increased risk for developing the major risk factors for CHD including cigarette smoking, hyperlipidemia, elevated blood pressure, physical inactivity, and less than optimal body weight.
The authors provide a nice overview of the risk factors included in these different risk assessment scores and their estimates of internal and external validity (e.g., generalizability) using different analytic approaches. This portion of the article should be of particular interest to researchers in the field and practicing clinicians as the characteristics of the respective study populations, factors included in each of these risk algorithms, and the endpoints examined are clearly laid out. Areas under the curve for each of these risk scores were calculated which provides insights to the utility of each of these risk scores, estimation of actual risk, as well as a discussion of their ease of administration.
Finally, the article concludes by summarizing the implications for policymaking of the eight risk scores examined and their potential use in developing countries for identifying men and women at increased risk for CVD in whom increased surveillance efforts and use of different preventive and treatment approaches can be more effectively targeted and utilized.
Reply to this message
© 2010 ProCor | Privacy Policy