Evaluating CMR

Some Framingham milestones

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In keeping with previous studies, the Framingham Heart Study also established the role of blood pressure in the development of CVD in young and elderly adults (32, 33). Framingham data has shown that each increment of blood pressure increases the risk of CVD (34). Among the major findings of Framingham, smoking was also found to increase the risk of MI, with risk increasing with the number of cigarettes smoked (7). Filter cigarettes were also found to provide no protection against CHD. In addition, type 2 diabetes was linked to multiple CHD risk factors and a twofold and threefold increase in CHD risk in men and women, respectively (35). The Framingham Heart Study also highlighted the role of obesity and lack of physical activity in CHD (36, 37). Obesity was tied to higher CHD rates (38, 39) and shown to be accompanied by multiple risk factors such as hypertension, glucose intolerance, and low HDL cholesterol.

Additional studies have attempted to determine the accuracy of the Framingham model in predicting CHD risk in other populations. Ramachandran et al. (40) verified the applicability of the Framingham score in 1,700 men and women from the United Kingdom. The authors found that the Framingham risk score underestimates CHD risk when absolute risk is lower, suggesting that the Framingham model is less accurate when applied to low-risk populations (41). Similarly, Brindle et al. (42), examined the accuracy of the Framingham risk score in predicting CHD in 6,643 middle-aged British men from 54 towns in the United Kingdom. Like Cooper et al. (43), the authors found that Framingham risk score significantly overestimated the absolute coronary risk of individuals in the United Kingdom.

Taking a similar approach, Empana et al. (47) compared the applicability of Framingham and PROspective CArdiovascular Münster study (PROCAM) (44) risk functions in middle-aged men from Northern Ireland and France in the Prospective Epidemiological Study of Myocardial Infarction (étude PRospective de l’Infractus du MyocardE-PRIME) cohort study.

Reference

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7. National Heart, Lung, and Blood Institute (NHLBI), http://www.nhlbi.nih.gov/about/framingham/, last accessed in August 2007.

32. Keys A, Menotti A, Aravanis C, et al. The seven countries study: 2,289 deaths in 15 years. Prev Med 1984; 13: 141-54.

33. Stokes JI, Kannel WB and P.A. W. Blood presure as a risk factor for cardiovascular disease. Hypertension 1989; 13-8.

34. Kannel WB, Wolf PA and Garrison RJ. Some risk factors related to the annual incidence of cardiovascular disease and death using pooled repeated biennial measurements: Framingham Heart Study, 30-year follow-up. Springfield, National Technical Information Service. 1987; 1-459.

35. Wilson PW. Diabetes mellitus and coronary heart disease. Am J Kidney Dis 1998; 32: S89-100.

36. Kannel WB. Habitual level of physical activity and risk of coronary heart disease: the Framingham study. Can Med Assoc J 1967; 96: 811-2.

37. Kannel WB, LeBauer EJ, Dawber TR, et al. Relation of body weight to development of coronary heart disease. The Framingham study. Circulation 1967; 35: 734-44.

38. Hubert HB, Feinleib M, McNamara PM, et al. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 1983; 67: 968-77.

39. Manson JE, Colditz GA, Stampfer MJ, et al. A prospective study of obesity and risk of coronary heart disease in women. N Engl J Med 1990; 322: 882-9.

40. Ramachandran S, French JM, Vanderpump MP, et al. Using the Framingham model to predict heart disease in the United Kingdom: retrospective study. BMJ 2000; 320: 676-7.

41. Kannel WB and Larson M. Long-term epidemiologic prediction of coronary disease. The Framingham experience. Cardiology 1993; 82: 137-52.

42. Brindle P, Emberson J, Lampe F, et al. Predictive accuracy of the Framingham coronary risk score in British men: prospective cohort study. BMJ 2003; 327: 1267.

43. Cooper JA, Miller GJ and Humphries SE. A comparison of the PROCAM and Framingham point-scoring systems for estimation of individual risk of coronary heart disease in the Second Northwick Park Heart Study. Atherosclerosis 2005; 181: 93-100.

44. Assmann G, Cullen P and Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Munster (PROCAM) study. Circulation 2002; 105: 310-5.

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