Predicting the Thirty-year Risk of Cardiovascular Disease: The Framingham Heart Study
By Michael J. Pencina, Ralph B. D’Agostino, Martin G. Larson, J. Massaro, Ramachandran S. Vasan. Circulation, 2009
869 citations recorded by the source corpus.
Background— Present cardiovascular disease (CVD) risk prediction algorithms were developed for a ≤10-year follow up period. Clustering of risk factors at younger ages and increasing life expectancy suggest the need for longer-term risk prediction tools. Methods and Results— We prospectively followed 4506 participants (2333 women) of the Framingham Offspring cohort aged 20 to 59 years and free of CVD and cancer at baseline examination in 1971–1974 for the development of “hard” CVD events (coronary death, myocardial infarction, stroke). We used a modified Cox model that allows adjustment for competing risk of noncardiovascular death to construct a prediction algorithm for 30-year risk of hard CVD. Cross-validated survival C statistic and calibration &khgr;2 were used to assess model performance. The 30-year hard CVD event rates adjusted for the competing risk of death were 7.6% for women and 18.3% for men. Standard risk factors (male sex, systolic blood pressure, antihypertensive treatment, total and high-density lipoprotein cholesterol, smoking, and diabetes mellitus), measured at baseline, were significantly related to the incidence of hard CVD and remained significant when updated regularly on follow-up. Body mass index was associated positively with 30-year risk of hard CVD only in models that did not update risk factors. Model performance was excellent as indicated by cross-validated discrimination C=0.803 and calibration &khgr;2=4.25 (P=0.894). In contrast, 30-year risk predictions based on different applications of 10-year functions proved inadequate. Conclusions— Standard risk factors remain strong predictors of hard CVD over extended follow-up. Thirty-year risk prediction functions offer additional risk burden information that complements that of 10-year functions.
Subfields: Cardiology and Cardiovascular Medicine, Health Information Management, Surgery
View Paper: https://www.semanticscholar.org/paper/d8f8c1812215ae1324924643652fd04e80d4dc37
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Citations in the corpus
- National Lipid Association Recommendations for Patient-Centered Management of Dyslipidemia: Part 2. (2015, methodology): “However, both the Framingham Risk Score and the ACC/AHA Pooled Cohort Equations provide lifetime risk estimates.(362,599) Most HIV cohort studies have followed patients for less than ten years; hence, there are no lifetime risk scores for patients infected with HIV.”
- 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. (2010, neutral): “Another approach to the ong-term risk estimation problem in younger adults was ecently presented by the Framingham Study investigators s the “30-Year Risk of Cardiovascular Disease” (54).”
- National lipid association recommendations for patient-centered management of dyslipidemia: part 1--full report. (2015, background): “In such individuals, calculation of long-term or lifetime risk may be particularly useful as an adjunct to the 10-year ASCVD or CHD event risk.(113,114) However, most risk equations do not incorporate additional risk indicators, which may be important to consider in specific patients.”
- Correlation study of Framingham risk score and vascular dementia (2017, methodology): “The sample size was calculated by taking the previously quoted study into account.([19,20]) A significance level of 5% for a 2-sided”