Evaluating CMR

Some Framingham milestones

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A recent study by Wannamethee et al. (51) compared the ability of the Framingham risk score vs. the metabolic syndrome to predict CHD, stroke, and type 2 diabetes in 5,128 middle-aged men with no history of CVD who were followed for 20 years. The study showed that the Framingham risk score was a better predictor of CHD and stroke than the metabolic syndrome, defined as the presence of three or more metabolic abnormalities based on modified NCEP-ATP III guidelines (52). This supports previous findings that the metabolic syndrome is less predictive of CHD than the Framingham risk score (53, 54). Moreover, a recent report of the NHLBI/American Heart Association conference (55) suggested that the addition of metabolic syndrome components to the Framingham risk score was of no additional value in risk assessment. This is likely due to the fact that, in comparison with metabolic syndrome prediction criteria, the Framingham risk score includes well-recognized CHD risk factors such as age, gender, total cholesterol levels, and smoking status. The Framingham risk score is therefore a better predictor of global CHD risk, while the metabolic syndrome is a better predictor of type 2 diabetes risk.

As early as the 1960s, the Framingham Heart Study had shown that several risk factors, such as age, smoking, hypertension, dyslipidemia, and diabetes, were major independent predictors of CVD. The Framingham Heart Study helped develop the concept of “risk factors”, a concept that is now commonplace. The notion of modifying “risk factors” to prevent heart disease has become an integral part of modern medical practice. The Framingham Heart Study has shaped CVD prevention in medical practice, and the Framingham risk score has become a useful tool to educate health professionals on how risk factors interact to increase CVD risk. Over the past 50 years, the Framingham Heart Study has been discussed in some 1,200 research articles in leading journals and achieved international recognition.

For more information, please visit the NHLBI website at http://www.nhlbi.nih.gov/about/framingham/index.html

Reference

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51. Wannamethee SG, Shaper AG, Lennon L, et al. Metabolic syndrome vs Framingham Risk Score for prediction of coronary heart disease, stroke, and type 2 diabetes mellitus. Arch Intern Med 2005; 165: 2644-50.

52. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486-97.

53. Stern MP, Williams K, Gonzalez-Villalpando C, et al. Does the metabolic syndrome improve identification of individuals at risk of type 2 diabetes and/or cardiovascular disease? Diabetes Care 2004; 27: 2676-81.

54. McNeill AM, Rosamond WD, Girman CJ, et al. The metabolic syndrome and 11-year risk of incident cardiovascular disease in the atherosclerosis risk in communities study. Diabetes Care 2005; 28: 385-90.

55. Grundy SM, Brewer HB, Jr., Cleeman JI, et al. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004; 109: 433-8.

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