Evaluating CMR
Assessing CVD Risk: Traditional Approaches
Framingham
- 1Key Points (1 page)
- 2The Framingham Heart Study (2 pages)
- 3Evaluating CHD risk (2 pages)
- 4Some Framingham milestones (4 pages)
- 5References (1 page)
Some Framingham milestones
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The Framingham Heart Study has led to the identification of major CHD risk factors and provided evidence that these factors have a cumulative effect in predicting CHD events. Accordingly, total CHD risk can be estimated by summing the risk imparted by each of the major risk factors (22). Conventional CHD risk factors include age, dyslipidemia, hypertension, smoking, and diabetes. Recent epidemiological studies (4, 5) have shown that patients with CHD have at least one of the four major modifiable risk factors (elevated total cholesterol, hypertension, smoking, diabetes). However, most patients without CHD also have at least one risk factor, which indicates that factors other than traditional risk factors may play a role in predicting CHD risk (23, 24).
Moreover, CHD risk is known to increase with age (8) independent of the age-related change in other risk factors. The results of the Framingham Heart Study have revealed a strong and positive relationship between blood cholesterol levels and CHD risk (25). However, it is no longer sufficient to only consider total cholesterol as a coronary artery disease (CAD) risk factor (26). There is considerable evidence indicating that both elevated LDL cholesterol and low HDL cholesterol strongly increase 10 year risk of CHD (8). In addition, data from the Framingham study has indicated that LDL and HDL cholesterol can better predict CHD than plasma triglycerides, which were not included in the prediction model (27). However, other studies have suggested that triglycerides are also an independent CHD risk factor (28, 29). Recent evidence also suggests that nonfasting triglyceride levels can be useful markers of CVD risk (30, 31). For example, in a study of 6,394 men and 7,587 women from the general population of Copenhagen, Denmark, Nordestgaard et al. (30) reported that elevated nonfasting triglyceride concentrations independently increased risk of MI, ischemic heart disease (IHD), and death over a median follow-up of 26 years. Bansal et al. (31) have also tied elevated nonfasting triglyceride levels to risk of future cardiovascular events. In this prospective study of 26,509 initially healthy women (20,118 fasting and 6,391 nonfasting) with a median follow-up of 11.4 years, nonfasting triglyceride levels predicted CVD even after adjusting for traditional CVD risk factors such as age, blood pressure, smoking, total cholesterol, and HDL cholesterol. These results lend weight to the theory that postprandial hypertriglyceridemia may indicate a dysmetabolic profile conducive to atherosclerosis and CVD.
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