From the Framingham Heart Study, National Heart, Lung, and Blood
Institute, Framingham, Mass (P.W.F.W., D.L.); Boston University Mathematics
Department, Boston, Mass (R.B.D., A.M.B., H.S.); and Framingham Heart Study,
Boston University School of Medicine, Framingham, Mass (W.B.K.).
Background—The objective of this
study was to examine the association of Joint National Committee
(JNC-V) blood pressure and National Cholesterol Education
Program (NCEP) cholesterol categories with coronary
heart disease (CHD) risk, to incorporate them into coronary
prediction algorithms, and to compare the discrimination properties of
this approach with other noncategorical prediction functions.
Methods and Results—This work was designed as a prospective,
single-center study in the setting of a community-based cohort. The
patients were 2489 men and 2856 women 30 to 74 years old at baseline
with 12 years of follow-up. During the 12 years of follow-up, a total
of 383 men and 227 women developed CHD, which was significantly
associated with categories of blood pressure, total
cholesterol, LDL cholesterol, and HDL
cholesterol (all P<.001). Sex-specific
prediction equations were formulated to predict CHD risk according to
age, diabetes, smoking, JNC-V blood pressure categories, and NCEP total
cholesterol and LDL cholesterol categories. The
accuracy of this categorical approach was found to be comparable to CHD
prediction when the continuous variables themselves were used.
After adjustment for other factors,
Conclusions—Recommended guidelines of blood pressure, total
cholesterol, and LDL cholesterol effectively
predict CHD risk in a middle-aged white population sample. A simple
coronary disease prediction algorithm was developed using
categorical variables, which allows physicians to predict
multivariate CHD risk in patients without overt CHD.
© 1998 American Heart Association, Inc.
Special Reports
Prediction of Coronary Heart Disease Using Risk Factor Categories
28% of CHD events in men and
29% in women were attributable to blood pressure levels that exceeded
high normal (
130/85). The corresponding multivariable-adjusted
attributable risk percent associated with elevated total
cholesterol (200 mg/dL) was 27% in men and 34% in
women.
Key Words: coronary disease • prediction • hypertension • cholesterol
This article has been cited by other articles:
 |
|
 |
|
  K. M. Johnson, D. A. Dowe, and J. A. Brink Traditional Clinical Risk Assessment Tools Do Not Accurately Predict Coronary Atherosclerotic Plaque Burden: A CT Angiography Study Am. J. Roentgenol., January 1, 2009; 192(1): 235 - 243. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. M. Rodriguez-Colon, J. Mo, Y. Duan, J. Liu, J. E. Caulfield, X. Jin, and D. Liao Metabolic Syndrome Clusters and the Risk of Incident Stroke: The Atherosclerosis Risk in Communities (ARIC) Study Stroke, January 1, 2009; 40(1): 200 - 205. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. S. Frankel, R. S. Vasan, R. B. D'Agostino Sr, E. J. Benjamin, D. Levy, T. J. Wang, and J. B. Meigs Resistin, Adiponectin, and Risk of Heart Failure: The Framingham Offspring Study J. Am. Coll. Cardiol., December 22, 2008; (2008) j.jacc.2008.07.073v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Kumar, R. J. Prineas, A. M. Arnold, B. M. Psaty, C. D. Furberg, J. Robbins, and D. M. Lloyd-Jones Prevalence, Prognosis, and Implications of Isolated Minor Nonspecific ST-Segment and T-Wave Abnormalities in Older Adults: Cardiovascular Health Study Circulation, December 16, 2008; 118(25): 2790 - 2796. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Shankar, W.-P. Koh, J.-M. Yuan, H.-P. Lee, and M. C. Yu Sleep Duration and Coronary Heart Disease Mortality Among Chinese Adults in Singapore: A Population-based Cohort Study Am. J. Epidemiol., December 15, 2008; 168(12): 1367 - 1373. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. I. Pollin, C. M. Damcott, H. Shen, S. H. Ott, J. Shelton, R. B. Horenstein, W. Post, J. C. McLenithan, L. F. Bielak, P. A. Peyser, et al. A Null Mutation in Human APOC3 Confers a Favorable Plasma Lipid Profile and Apparent Cardioprotection Science, December 12, 2008; 322(5908): 1702 - 1705. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. W.F. Wilson Progressing From Risk Factors to Omics Circ Cardiovasc Genet, December 1, 2008; 1(2): 141 - 146. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Alves and A. Azevedo Hypercholesterolemia, eligibility for lipid-lowering therapy and therapeutic success: population-based study in a Portuguese urban population Eur. J. Endocrinol., December 1, 2008; 159(6): 755 - 760. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Williams, A. Tchernof, K. J. Hunt, L. E. Wagenknecht, S. M. Haffner, and A. D. Sniderman Diabetes, Abdominal Adiposity, and Atherogenic Dyslipoproteinemia in Women Compared With Men Diabetes, December 1, 2008; 57(12): 3289 - 3296. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S E Gabriel Why do people with rheumatoid arthritis still die prematurely? Ann Rheum Dis, December 1, 2008; 67(Suppl_3): iii30 - iii34. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. McGeechan, P. Macaskill, L. Irwig, G. Liew, and T. Y. Wong Assessing New Biomarkers and Predictive Models for Use in Clinical Practice: A Clinician's Guide Arch Intern Med, November 24, 2008; 168(21): 2304 - 2310. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. J. Koopman, A. G. Mainous III, C. J. Everett, and R. E. Carter Tool to Assess Likelihood of Fasting Glucose ImpairmenT (TAG-IT) Ann. Fam. Med, November 1, 2008; 6(6): 555 - 561. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. W.F. Wilson, M. Pencina, P. Jacques, J. Selhub, R. D'Agostino Sr, and C. J. O'Donnell C-Reactive Protein and Reclassification of Cardiovascular Risk in the Framingham Heart Study Circ Cardiovasc Qual Outcomes, November 1, 2008; 1(2): 92 - 97. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Zhou, X. Zhang, M. He, L. Cheng, Y. Chen, F. B. Hu, and T. Wu Associations Between Single Nucleotide Polymorphisms on Chromosome 9p21 and Risk of Coronary Heart Disease in Chinese Han Population Arterioscler. Thromb. Vasc. Biol., November 1, 2008; 28(11): 2085 - 2089. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Shah, J. P Casas, J. A Cooper, I. Tzoulaki, R. Sofat, V. McCormack, L. Smeeth, J. E Deanfield, G. D Lowe, A. Rumley, et al. Critical appraisal of CRP measurement for the prediction of coronary heart disease events: new data and systematic review of 31 prospective cohorts Int. J. Epidemiol., October 17, 2008; (2008) dyn217v1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Gossl, U. I. Modder, E. J. Atkinson, A. Lerman, and S. Khosla Osteocalcin Expression by Circulating Endothelial Progenitor Cells in Patients With Coronary Atherosclerosis J. Am. Coll. Cardiol., October 14, 2008; 52(16): 1314 - 1325. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Wingrove, S. E. Daniels, A. J. Sehnert, W. Tingley, M. R. Elashoff, S. Rosenberg, L. Buellesfeld, E. Grube, L. K. Newby, G. S. Ginsburg, et al. Correlation of Peripheral-Blood Gene Expression With the Extent of Coronary Artery Stenosis Circ Cardiovasc Genet, October 1, 2008; 1(1): 31 - 38. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. J. O'Donnell and E. G. Nabel Cardiovascular Genomics, Personalized Medicine, and the National Heart, Lung, and Blood Institute: Part I: The Beginning of an Era Circ Cardiovasc Genet, October 1, 2008; 1(1): 51 - 57. [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Kulminski, S. V. Ukraintseva, I. V. Culminskaya, K. G. Arbeev, K. C. Land, L. Akushevich, and A. I. Yashin Cumulative Deficits and Physiological Indices as Predictors of Mortality and Long Life J. Gerontol. A Biol. Sci. Med. Sci., October 1, 2008; 63(10): 1053 - 1059. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Z. T. Bloomgarden American College of Endocrinology Pre-Diabetes Consensus Conference: Part One Diabetes Care, October 1, 2008; 31(10): 2062 - 2069. [Full Text] [PDF]
|
|
|
|
 |
|
 J. L. Rosenzweig, E. Ferrannini, S. M. Grundy, S. M. Haffner, R. J. Heine, E. S. Horton, and R. Kawamori Primary Prevention of Cardiovascular Disease and Type 2 Diabetes in Patients at Metabolic Risk: An Endocrine Society Clinical Practice Guideline J. Clin. Endocrinol. Metab., October 1, 2008; 93(10): 3671 - 3689. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M Sandrock, C Schulze, D Schmitz, H-H Dickhuth, and A Schmidt-Trucksaess Physical activity throughout life reduces the atherosclerotic wall process in the carotid artery Br. J. Sports Med., October 1, 2008; 42(10): 839 - 844. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. M. Eggers, L. Lind, H. Ahlstrom, T. Bjerner, C. Ebeling Barbier, A. Larsson, P. Venge, and B. Lindahl Prevalence and pathophysiological mechanisms of elevated cardiac troponin I levels in a population-based sample of elderly subjects Eur. Heart J., September 2, 2008; 29(18): 2252 - 2258. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. G. Mainous III, C. J. Everett, M. S. Player, D. E. King, and V. A. Diaz Importance of a Patient's Personal Health History on Assessments of Future Risk of Coronary Heart Disease J Am Board Fam Med, September 1, 2008; 21(5): 408 - 413. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Liew, J. J. Wang, P. Mitchell, and T. Y. Wong Retinal Vascular Imaging: A New Tool in Microvascular Disease Research Circ Cardiovasc Imaging, September 1, 2008; 1(2): 156 - 161. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Wong, M. Freiberg, R. Tracy, and L. Kuller Epidemiology of Cytokines: The Women On the Move through Activity and Nutrition (WOMAN) Study Am. J. Epidemiol., August 15, 2008; 168(4): 443 - 453. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Daniels, G. A. Laughlin, P. Clopton, A. S. Maisel, and E. Barrett-Connor Minimally Elevated Cardiac Troponin T and Elevated N-Terminal Pro-B-Type Natriuretic Peptide Predict Mortality in Older Adults: Results From the Rancho Bernardo Study J. Am. Coll. Cardiol., August 5, 2008; 52(6): 450 - 459. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Tacoy, A. S. Balcioglu, S. Akinci, G. Erdem, S. A. Kocaman, T. Timurkaynak, and A. Cengel Traditional Risk Factors Are Predictive on Segmental Localization of Coronary Artery Disease Angiology, August 1, 2008; 59(4): 402 - 407. [Abstract] [PDF]
|
|
|
|
 |
|
 G. Schillaci, G. V.L. De Socio, G. Pucci, M. R. Mannarino, J. Helou, M. Pirro, and E. Mannarino Aortic Stiffness in Untreated Adult Patients With Human Immunodeficiency Virus Infection Hypertension, August 1, 2008; 52(2): 308 - 313. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Ye, J. Willeit, F. Kronenberg, Q. Xu, and S. Kiechl Association of Genetic Variation on Chromosome 9p21 With Susceptibility and Progression of Atherosclerosis: A Population-Based, Prospective Study J. Am. Coll. Cardiol., July 29, 2008; 52(5): 378 - 384. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Qasim, N. N. Mehta, M. G. Tadesse, M. L. Wolfe, T. Rhodes, C. Girman, and M. P. Reilly Adipokines, insulin resistance, and coronary artery calcification. J. Am. Coll. Cardiol., July 15, 2008; 52(3): 231 - 236. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Ankle Brachial Index Collaboration Ankle Brachial Index Combined With Framingham Risk Score to Predict Cardiovascular Events and Mortality: A Meta-analysis JAMA, July 9, 2008; 300(2): 197 - 208. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. K. Grinspoon, C. Grunfeld, D. P. Kotler, J. S. Currier, J. D. Lundgren, M. P. Dube, S. E. Lipshultz, P. Y. Hsue, K. Squires, M. Schambelan, et al. State of the Science Conference: Initiative to Decrease Cardiovascular Risk and Increase Quality of Care for Patients Living With HIV/AIDS: Executive Summary Circulation, July 8, 2008; 118(2): 198 - 210. [Full Text] [PDF]
|
|
|
|
|
|
J. S. Currier, J. D. Lundgren, A. Carr, D. Klein, C. A. Sabin, P. E. Sax, J. T. Schouten, M. Smieja, and for Working Group 2 Epidemiological Evidence for Cardiovascular Disease in HIV-Infected Patients and Relationship to Highly Active Antiretroviral Therapy Circulation, July 8, 2008; 118(2): e29 - e35. [Full Text] [PDF]
|
|
|
|
|
|
P. Y. Hsue, K. Squires, A. F. Bolger, B. Capili, G. A. Mensah, Z. Temesgen, C. A. Wanke, D. A. Wohl, and for Working Group 4 Screening and Assessment of Coronary Heart Disease in HIV-Infected Patients Circulation, July 8, 2008; 118(2): e41 - e47. [Full Text] [PDF]
|
|
|
|
|
|
M. Schambelan, P. W.F. Wilson, K. E. Yarasheski, W. T. Cade, V. G. Davila-Roman, R. B. D'Agostino Sr, T. A. Helmy, M. Law, K. E. Mondy, S. Nachman, et al. Development of Appropriate Coronary Heart Disease Risk Prediction Models in HIV-Infected Patients Circulation, July 8, 2008; 118(2): e48 - e53. [Full Text] [PDF]
|
|
|
|
|
|
P. W.F. Wilson, S. R. Bozeman, T. M. Burton, D. C. Hoaglin, R. Ben-Joseph, and C. L. Pashos Prediction of First Events of Coronary Heart Disease and Stroke With Consideration of Adiposity Circulation, July 8, 2008; 118(2): 124 - 130. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Klem, S. Greulich, J. F. Heitner, H. Kim, H. Vogelsberg, E.-M. Kispert, S. R. Ambati, C. Bruch, M. Parker, R. M. Judd, et al. Value of Cardiovascular Magnetic Resonance Stress Perfusion Testing for the Detection of Coronary Artery Disease in Women J. Am. Coll. Cardiol. Img., July 1, 2008; 1(4): 436 - 445. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. S. Huang, Q. Zhang, N. Gandra, M. H. Chin, and D. O. Meltzer The Effect of Comorbid Illness and Functional Status on the Expected Benefits of Intensive Glucose Control in Older Patients with Type 2 Diabetes: A Decision Analysis Ann Intern Med, July 1, 2008; 149(1): 11 - 19. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. K. Jensen, S. E. Chiuve, E. B. Rimm, C. Dethlefsen, A. Tjonneland, A. M. Joensen, and K. Overvad Obesity, Behavioral Lifestyle Factors, and Risk of Acute Coronary Events Circulation, June 17, 2008; 117(24): 3062 - 3069. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Mozaffarian, P. W.F. Wilson, and W. B. Kannel Beyond Established and Novel Risk Factors: Lifestyle Risk Factors for Cardiovascular Disease Circulation, June 10, 2008; 117(23): 3031 - 3038. [Full Text] [PDF]
|
|
|
|
|
|
R. K. Simmons, S. Sharp, S. M. Boekholdt, L. A. Sargeant, K.-T. Khaw, N. J. Wareham, and S. J. Griffin Evaluation of the Framingham Risk Score in the European Prospective Investigation of Cancer-Norfolk Cohort: Does Adding Glycated Hemoglobin Improve the Prediction of Coronary Heart Disease Events? Arch Intern Med, June 9, 2008; 168(11): 1209 - 1216. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Pencina and R. B. D'Agostino Evaluation of the Framingham Risk Score in the European Prospective Investigation of Cancer-Norfolk Cohort--Invited Commentary Arch Intern Med, June 9, 2008; 168(11): 1216 - 1218. [Full Text] [PDF]
|
|
|
|
 |
|
 R. C. Becker, T. W. Meade, P. B. Berger, M. Ezekowitz, C. M. O'Connor, D. A. Vorchheimer, G. H. Guyatt, D. B. Mark, and R. A. Harrington The Primary and Secondary Prevention of Coronary Artery Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 776S - 814S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. See, J. B. Lindsey, M. J. Patel, C. R. Ayers, A. Khera, D. K. McGuire, S. M. Grundy, and J. A. de Lemos Application of the Screening for Heart Attack Prevention and Education Task Force Recommendations to an Urban Population: Observations From the Dallas Heart Study Arch Intern Med, May 26, 2008; 168(10): 1055 - 1062. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Mozaffarian, A. Kamineni, R. J. Prineas, and D. S. Siscovick Metabolic Syndrome and Mortality in Older Adults: The Cardiovascular Health Study Arch Intern Med, May 12, 2008; 168(9): 969 - 978. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Liu, N. M. Paige, C. L. Goldzweig, E. Wong, A. Zhou, M. J. Suttorp, B. Munjas, E. Orwoll, and P. Shekelle Screening for Osteoporosis in Men: A Systematic Review for an American College of Physicians Guideline Ann Intern Med, May 6, 2008; 148(9): 685 - 701. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. P. Martins, C. O. Nastri, R. A. Ferriani, and F. M. Filho Brachial Artery Pulsatility Index Change 1 Minute After 5-Minute Forearm Compression: Comparison With Flow-Mediated Dilatation J. Ultrasound Med., May 1, 2008; 27(5): 693 - 699. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Dora, C. K. Kramer, and L. H. Canani Standards of Medical Care in Diabetes--2008: Response to Hirsch, Inzucchi, and Kirkman Diabetes Care, May 1, 2008; 31(5): e44 - e44. [Full Text] [PDF]
|
|
|
|
 |
|
 R. A Dale, L. H Jensen, and M. J Krantz Comparison of Two Point-of-Care Lipid Analyzers for Use in Global Cardiovascular Risk Assessments Ann. Pharmacother., May 1, 2008; 42(5): 633 - 639. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. -T. Lee, K. Chu, K. -H. Jung, D. -H. Kim, E. -H. Kim, V. N. Choe, J. -H. Kim, W. -S. Im, L. Kang, J. -E. Park, et al. Decreased number and function of endothelial progenitor cells in patients with migraine Neurology, April 22, 2008; 70(17): 1510 - 1517. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. D. Solomon, J. Wittes, P. V. Finn, R. Fowler, J. Viner, M. M. Bertagnolli, N. Arber, B. Levin, C. L. Meinert, B. Martin, et al. Cardiovascular Risk of Celecoxib in 6 Randomized Placebo-Controlled Trials: The Cross Trial Safety Analysis Circulation, April 22, 2008; 117(16): 2104 - 2113. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Bos, P. J. Koudstaal, and M. M. B. Breteler Prognosis of Transient Neurological Attacks--Reply JAMA, April 16, 2008; 299(15): 1772 - 1773. [Full Text] [PDF]
|
|
|
|
 |
|
 N. Meka, S. Katragadda, B. Cherian, and R. R. Arora Review: Endurance exercise and resistance training in cardiovascular disease Therapeutic Advances in Cardiovascular Disease, April 1, 2008; 2(2): 115 - 121. [Abstract] [PDF]
|
|
|
|
|
|
J. E. Dimsdale Psychological Stress and Cardiovascular Disease J. Am. Coll. Cardiol., April 1, 2008; 51(13): 1237 - 1246. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Cai and S. Cheng Robust combination of multiple diagnostic tests for classifying censored event times Biostat., April 1, 2008; 9(2): 216 - 233. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Rundek, H. Arif, B. Boden-Albala, M. S. Elkind, M. C. Paik, and R. L. Sacco Carotid plaque, a subclinical precursor of vascular events: The Northern Manhattan Study Neurology, April 1, 2008; 70(14): 1200 - 1207. [Abstract] [Full Text] [PDF]
|
|
|
|