Stratifying the patient at risk from coronary disease: New insights from the Framingham Heart Study Although cardiovascular disease remains the leading cause of death in the United States, cardiovascular disease mortality has decreased steadily during the past 2 decades. This trend is largely attributable to improved detection and management of cardiovascular risk factors, in which the Framingham Heart Study has played a major role. This article examines some of the risk factors associated with coronary heart disease, notably, advancing age, hypertension, left ventricular hypertrophy, smoking, elevated serum cholesterol, and reduced high-density lipoprotein, all of which have been investigated by the Framingham Heart Study. In addition, new data are presented from a multidimensional model of coronary heart disease. This is a novel approach that takes into account the interactions of m~ulUple risk factors and their contribution to overall coronary heart disease risk. (AM HEARTJ 1990;119:712-7.)
Daniel Levy, MD, Peter W, F. Wilson, MD, Keaven M. Anderson, PhD, and William P. Castelli, MD Framingham, Mass.
The Framingham Heart Study began in 1948 with 5209 men and women between 30 and 52 years of age. At the start of the study, thorough histories and extensive physical examinations, blood tests, ECG assessments, and chest x-ray films were obtained. Persons have since been reassessed every 2 years, and those still surviving are currently undergoing their twentieth cycle of examinations.1 To date, 60 % of the original participants have died. The leading cause of death in this carefully studied population has been cardiovascular disease. This has provided a wealth of information on the natural history of cardiovascular disease and predisposing factors. In this article risk factors associated with cardiovascular disease are discussed. Age, sex, hypertension, left ventricular hypertrophy (LVH), smoking, cholesterol, and high-density lipoprotein (HDL) are considered, and the independent contribution of each risk factor to overall cardiovascular risk is assessed. A risk assessment algorithm is also presented, which incorporates levels of risk factors and estimates 10-year risk for coronary heart disease (CHD).
From the Framingham Heart Study9 Reprint requests: Daniel Levy, MD, Framingham Heart Study, 118 Lincoln St., Framingham, MA 01701. 4/0/17638 712
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Age at entry Fig. 1. Incidence of C H D over 14 years in F r a m i n g h a m m e n a n d women, ages 30 to 62 years. ( F r o m Castelli W P , A n d e r s o n K M . A m J M e d 1986;80([suppl 2A]):23-32.) AGE AND SEX
The risk of developing CHD is a function of age and sex (Fig. 1). 2 In men between 30 and 62 years of age, the incidence of CHD increases in a linear fashion with advancing age. Women are at a relatively low risk until menopause, after which the risk of CHD accelerates, but always remains lower than the risk in men. At any given level of risk, women lag behind men by 15 to 20 years.
Volume
119
New insights from Framingham
Number 3, Part 2
713
Age65-94 Age35-64
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Daniel Levy, MD, Peter W, F. Wilson, MD, Keaven M. Anderson, PhD, and William P. Castelli, MD Framingham, Mass.
The Framingham Heart Study began in 1948 with 5209 men and women between 30 and 52 years of age. At the start of the study, thorough histories and extensive physical examinations, blood tests, ECG assessments, and chest x-ray films were obtained. Persons have since been reassessed every 2 years, and those still surviving are currently undergoing their twentieth cycle of examinations.1 To date, 60 % of the original participants have died. The leading cause of death in this carefully studied population has been cardiovascular disease. This has provided a wealth of information on the natural history of cardiovascular disease and predisposing factors. In this article risk factors associated with cardiovascular disease are discussed. Age, sex, hypertension, left ventricular hypertrophy (LVH), smoking, cholesterol, and high-density lipoprotein (HDL) are considered, and the independent contribution of each risk factor to overall cardiovascular risk is assessed. A risk assessment algorithm is also presented, which incorporates levels of risk factors and estimates 10-year risk for coronary heart disease (CHD).
From the Framingham Heart Study9 Reprint requests: Daniel Levy, MD, Framingham Heart Study, 118 Lincoln St., Framingham, MA 01701. 4/0/17638 712
.
.
.
.
"::me
200 r
P Z O
100
30-34
35-39
40-44
I
I
I
45-49
50-54
55-59
60-62
Age at entry Fig. 1. Incidence of C H D over 14 years in F r a m i n g h a m m e n a n d women, ages 30 to 62 years. ( F r o m Castelli W P , A n d e r s o n K M . A m J M e d 1986;80([suppl 2A]):23-32.) AGE AND SEX
The risk of developing CHD is a function of age and sex (Fig. 1). 2 In men between 30 and 62 years of age, the incidence of CHD increases in a linear fashion with advancing age. Women are at a relatively low risk until menopause, after which the risk of CHD accelerates, but always remains lower than the risk in men. At any given level of risk, women lag behind men by 15 to 20 years.
Volume
119
New insights from Framingham
Number 3, Part 2
713
Age65-94 Age35-64
60 5O =
M
40
e
n
/
3O
. .. SSSS~%~
'I-
o
20
/
/S $
10 0
