What is the Framingham (Framingham Heart Study) study?

From the Guidelines

The Framingham Heart Study is a crucial tool for assessing cardiovascular risk, and its risk assessment tools, such as the Framingham Risk Score, should be used to calculate a patient's 10-year cardiovascular disease risk based on age, gender, cholesterol levels, blood pressure, smoking status, and diabetes 1. The Framingham Heart Study has been a landmark cardiovascular research project since 1948, following over 5,000 participants to identify risk factors for heart disease. This study established many of the major cardiovascular risk factors we recognize today, including high blood pressure, high cholesterol, smoking, obesity, diabetes, and physical inactivity. Some of the key advantages of using the Framingham algorithm include:

• Ready availability and ability to calculate risk using an online tool
• Familiarity among healthcare professionals
• Ability to provide quantitative absolute risk over a decade
• Incorporation of graded severity of risk factors, such as lipid levels However, there are also some potential disadvantages to using the Framingham algorithm, including:
• Limits in accounting for variability of risk factor levels across visits
• Difficulty accounting for purely historical risk factors
• Absence of several more recently appreciated risk factors, such as alcohol consumption, obesity, family history, high-sensitivity C-reactive protein, and physical activity
• Limited applicability to certain minority populations According to the 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults, global risk assessment instruments, such as the Framingham Risk Score, are considered valuable in medical practice because clinicians and patients may not otherwise accurately assess risk 1. Some of the key points from this guideline include:
• Global risk scores are designed to estimate risk across a continuous range from 0% to 100%
• Patients are deemed to be high risk if they are found to have a global risk estimate for hard CHD events of at least 20% over 10 years
• The threshold for dividing low risk from intermediate risk is not uniform, with some proposing a lower cutoff value of 6% risk over 10 years, whereas others use a value of 10% over 10 years Overall, the Framingham Heart Study and its risk assessment tools are essential for identifying high-risk individuals and implementing preventive strategies to reduce cardiovascular disease risk 1.

From the Research

Overview of the Framingham Study

• The Framingham study has been a leader in identifying cardiovascular disease (CVD) risk factors 2
• It has provided insights into the prevalence, incidence, prognosis, predisposing factors, and determinants of CVD 3
• The study has generated seminal findings on the effects of tobacco use, unhealthy diet, physical inactivity, obesity, raised blood cholesterol, raised blood pressure, and diabetes on CVD 3

Key Findings and Contributions

• The Framingham study developed the Framingham Risk Functions (also called Framingham Risk Scores) to evaluate the chance of developing CVD in individuals 2
• These functions combine information on CVD risk factors such as sex, age, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, smoking behavior, and diabetes status 2
• The study has contributed to the development of cardiovascular risk prediction equations for assessment of absolute risk 3
• It has also highlighted the importance of considering total cardiovascular risk rather than a single risk factor approach 3

Impact on Cardiovascular Disease Prevention

• The Framingham study has made a significant contribution to CVD prevention in the United States and globally 3
• Its findings have influenced global CVD prevention strategies and have led to a paradigm shift in CVD prevention approaches 3
• The study has emphasized the need for vigorous preventive measures, particularly in women, and has highlighted the importance of addressing glucose intolerance, abdominal obesity, and blood lipids 4

Risk Factors and Prevention

• The Framingham study has identified several risk factors for CVD, including high cholesterol, high blood pressure, tobacco use, and diabetes 5
• It has also shown that addressing these risk factors can reduce the chances of developing CVD 2, 3
• The study has highlighted the importance of using risk prediction equations, such as the Framingham Risk Scores, to assess an individual's risk of developing CVD and to guide preventive measures 2, 3