Studies Challenge Framingham Risk Score

The long-standing assessment for heart risk may not be accurate in some cases

By Ed Edelson
HealthDay Reporter

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THURSDAY, Jan. 8 (HealthDay News) -- Two studies, from the United States and the Netherlands, question the accuracy and value of the long-established Framingham Risk Score in predicting heart disease and cardiovascular death.

The Framingham score, based on findings of a decades-long study in that Massachusetts community, allows doctors to assess risk on the basis of seven factors: age, gender, total blood cholesterol, HDL (good) cholesterol, smoking status, systolic blood pressure (the higher of the desired 120 over 80 reading), and whether blood pressure medication is being taken.

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But use of that score did not accurately predict risk in a group of 1,653 people with no history of coronary heart disease, said a report in the January American Journal of Roentgenology. The study, by researchers at Yale University, measured the amount of potentially artery-blocking plaque seen on computerized tomography images.

While 21 percent of the people in the study were taking cholesterol-lowering statin drugs because of their Framingham scores, the scans showed that a quarter of those taking the medications had no detectable plaque, said Dr. Kevin M. Johnson, assistant clinical professor of diagnostic radiology at Yale, and lead author of the report.

"The rub is that the Framingham score is intended to talk about populations," Johnson said. "But the doctor in the office is faced by an individual patient who wants to know about his or her risk. If the doctor uses this Framingham score to assess risk for that individual patient, the results are not that good. If you look at 100 patients, it is accurate in a statistical sense, but that is epidemiology, not medicine."

The finding presents practicing physicians with a quandary, Johnson acknowledged, since it might mean exposing large numbers of healthy people to the X-rays needed to do CT artery scans.

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