Primary and subsequent coronary risk appraisal: New results from the Framingham study

Background Coronary heart disease continues to be one of the most common chronic illnesses in the United States and most of the developed world. Clinicians and health authorities have interest in identifying individuals at increased risk of CHD. The Framingham Heart Study has over the years produced mathematical “health risk appraisal models” that relate risk factors to the probability of developing CHD. Methods and Results New sex-specific models from The Framingham Heart Study for primary and secondary (subsequent) CHD have been produced. The primary CHD models are appropriate for assessing CHD risk in persons free of cardiovascular disease and contain risk factors such as triglyceride levels, alcohol use, and menopausal status, risk factors not included in previously published models. The subsequent CHD models are applicable for persons with a history of CHD or ischemic stroke who have survived the acute period after the event. Age, blood lipid levels (total cholesterol and HDL cholesterol), and diabetes status are significant for men and women. In addition, systolic blood pressure and cigarette smoking are significant predictors of subsequent CHD in women. Conclusions These new models are useful tools for better understanding the relation between risk factors and the occurrences of CHD events in individuals who are free of cardiovascular disease as well as persons who have had a prior CHD event or stroke. With the development of these latter models, the importance of blood lipid levels, diabetes, and, in women, systolic blood pressure and cigarette smoking as independent predictors of risk is once again underscored.