From the Guidelines
To apply the Framingham risk score, healthcare professionals should use the modified Framingham Stroke Risk Profile table to calculate the 10-year probability of stroke for patients 55–85 years of age and free of previous stroke, by summing points for each individual's characteristics such as age, systolic blood pressure, diabetes, cigarette smoking, cardiovascular disease, atrial fibrillation, and left ventricular hypertrophy. When using the Framingham risk score, it is essential to gather patient data including age, gender, systolic blood pressure, treatment for hypertension, diabetes status, smoking status, history of cardiovascular disease, atrial fibrillation, and left ventricular hypertrophy 1. The patient's characteristics are then matched to the corresponding point values in the table, and the total point score is calculated to determine the 10-year probability of stroke. For example, a 64-year-old man with a treated systolic blood pressure of 138 mm Hg, no diabetes, no smoking history, no cardiovascular disease, no atrial fibrillation, but with left ventricular hypertrophy, would have a total point score of 14 (3 points for age, 6 points for systolic blood pressure, 0 points for diabetes, 0 points for smoking, 0 points for cardiovascular disease, 0 points for atrial fibrillation, and 5 points for left ventricular hypertrophy), corresponding to a 17% 10-year probability of stroke 1. The Framingham risk score is a valuable tool for predicting the risk of stroke and can be used to guide treatment decisions, such as lifestyle modifications or medication interventions, to reduce the risk of stroke. Some key points to consider when using the Framingham risk score include:
- The score is based on data from the Framingham Heart Study and is applicable to patients 55–85 years of age and free of previous stroke 1.
- The score incorporates multiple risk factors, including age, systolic blood pressure, diabetes, cigarette smoking, cardiovascular disease, atrial fibrillation, and left ventricular hypertrophy, to provide a comprehensive assessment of stroke risk 1.
- The score can be used to categorize patients as low-risk, intermediate-risk, or high-risk for stroke, and to guide treatment decisions accordingly 1. It is also important to note that the Framingham risk score should be used in conjunction with clinical judgment and patient preferences when making treatment decisions, as it is a prediction tool and not a definitive diagnostic test 1.
From the Research
Applying the Framingham Risk Score
To apply the Framingham risk score, the following factors are considered:
- Age
- Sex
- Current smoking status
- Diabetes
- Systolic blood pressure (SBP)
- Total cholesterol
- High-density lipoprotein (HDL) cholesterol 2, 3, 4
Calculation of the Framingham Risk Score
The Framingham risk score is calculated using the above factors to predict the 10-year risk of coronary heart disease (CHD) or cardiovascular disease (CVD) 2, 3, 5, 6, 4.
Interpretation of the Framingham Risk Score
The results of the Framingham risk score can be interpreted as follows:
- Low risk: less than 10% 10-year risk of CHD or CVD
- Intermediate risk: 10-20% 10-year risk of CHD or CVD
- High risk: greater than 20% 10-year risk of CHD or CVD 5, 6
Limitations and Considerations
Some studies have found that the Framingham risk score may not be accurate for certain populations, such as Australian Indigenous cohorts 6, and may require recalibration for these groups. Additionally, the score may not capture all risk factors for CHD or CVD, and other tools, such as the Ideal Cardiovascular Health (IDEAL) score, may be more sensitive to positive changes in cardiovascular health 3.
Available Tools for Calculation
Several tools are available to calculate the Framingham risk score, including risk charts and computerized calculators for personal digital assistants, personal computers, and web-based use 4. These tools are generally easy to use and require information on the above factors.