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Framingham-based tools to calculate the global risk of coronary heart disease: A systematic review of tools for clinicians
Open accessAbstract
Purpose To examine the features of available Framingham-based risk calculation tools and review their accuracy and feasibility in clinical practice.Data sources medline, 1966-April 2003, and the google search engine on the Internet. TOOL AND STUDY SELECTION: We included risk calculation tools that used the Framingham risk equations to generate a global coronary heart disease (CHD) risk. To determine tool accuracy, we reviewed all articles that compared the performance of various Framingham-based risk tools to that of the continuous Framingham risk equations. To determine the feasibility of tool use in clinical practice, we reviewed articles on the availability of the risk factor information required for risk calculation, subjective preference for 1 risk calculator over another, or subjective ease of use.Data extraction Two reviewers independently reviewed the results of the literature search, all websites, and abstracted all articles for relevant information.Data synthesis Multiple CHD risk calculation tools are available, including risk charts and computerized calculators for personal digital assistants, personal computers, and web-based use. Most are easy to use and available without cost. They require information on age, smoking status, blood pressure, total and HDL cholesterol, and the presence or absence of diabetes. Compared to the full Framingham equations, accuracy for identifying patients at increased risk was generally quite high. Data on the feasibility of tool use was limited.Conclusions Several easy-to-use tools are available for estimating patients' CHD risk. Use of such tools could facilitate better decision making about interventions for primary prevention of CHD, but further research about their actual effect on clinical practice and patient outcomes is required.
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“For many decades, a low level of HDL-C has been viewed as a robust and independent CVD risk factor1-4.”
From Is Isolated Low High-Density Lipoprotein Cholesterol a Cardiovascular Disease Risk Factor?: New Insights From the Framingham Offspring Study (2016) · cites this paper as [2]
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“have been documented as a critical risk factor for estimating 10-year risk of CVD2.”
From Is Isolated Low High-Density Lipoprotein Cholesterol a Cardiovascular Disease Risk Factor?: New Insights From the Framingham Offspring Study (2016) · cites this paper as [2]
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“Although risk calculators based on the Framingham Heart Study are most commonly recommended for CVD risk calculation in the US, diabetes is underrepresented in the Framingham cohort, making the equations imprecise in estimating CVD risk in persons with diabetes (Sheridan et al 2003).”
MethodPetersson, U., Östgren, C. J., Brudin, L. H., & Nilsson, P. M. (2009) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/hjr.0b013e32832b1833 · Cited by 13
Liu, Y., Mentele, L. J., McDonough, R. P., Carruthers, K. M., & Doucette, W. R. (2008) · Journal of the American Pharmacists Association · doi:10.1331/japha.2008.07099 · Cited by 12
Framingham risk-based survival of non-small-cell lung cancer
Poullis, M. P., McShane, J., Shaw, M., Page, R. M., Shackcloth, M. J., & Mediratta, N. (2012) · Asian Cardiovascular and Thoracic Annals · doi:10.1177/0218492311432801 · Cited by 11
“The limitations of the Framingham model are well described, however, this model is widely used in academic publications.(16) The risks and benefits of medication will need to be balanced against the Framingham risk of cardiovascular events.”
MethodLee, H.-R., Kim, J.-K., Kim, J., & Chung, T. (2021) · Clinica Chimica Acta · doi:10.1016/j.cca.2021.05.029 · Cited by 10
Qureshi, N., Armstrong, S., Saukko, P. M., Sach, T., Middlemass, J., Evans, P. H., Kai, J., Farrimond, H. R., & Humphries, S. E. (2009) · BMC Health Services Research · doi:10.1186/1472-6963-9-184 · Cited by 11
Pijl, M., Henneman, L., Cross-Bardell, L., Timmermans, D. R. M., & Qureshi, N. (2011) · Genetics in Medicine · doi:10.1097/gim.0b013e3182081fce · Cited by 10
The vulnerable patient: Refocusing on the plaque?
Heeneman, S., Daemen, M. J. A. P., & Eijgelaar, W. J. (2009) · Thrombosis and Haemostasis · doi:10.1160/th09-01-0030 · Cited by 10
Huang, J., Li, R.-H., Huang, S.-L., Sia, H., Yu, C.-H., & Tang, F. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18137103 · Cited by 9
Aghav, J. V., Sonawane, S., & Bhambhlani, H. (2014) · International Conference on Advances in Engineering & Technology Research · doi:10.1109/icaetr.2014.7012893 · Cited by 9
“ECG gives three label [16] 1) Atrial Fibrillation 2) Myocardial Infarction 3) Heart Block after analysis.”
MethodWaldeck, A. R., Botteman, M. F., White, R. E., & van Hout, B. A. (2017) · Journal of Managed Care & Specialty Pharmacy · doi:10.18553/jmcp.2017.23.6-a.s6 · Cited by 9
“calculators allow one to estimate a patient’s absolute 10-year risk of death based on a set of validated risk factors or covariates.(40) ■■ Measures of Risk and Their Relevance to the Individual Patient”
BackgroundAssociation between HDL-C concentration and risk for a major cardiovascular event
Laitinen, D. L., Manthena, S. R., & Webb, S. F. (2010) · Current Medical Research and Opinion · doi:10.1185/03007991003656968 · Cited by 9
Metadata
- Authors
- Sheridan, S., Pignone, M., & Mulrow, C.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- The University of Texas at San Antonio Health Science Center (US)
- Corresponding author
- Sheridan, Stacey
- Venue
- Journal of General Internal Medicine
- Published
- 2003-12
- Volume
- 18
- Issue
- 12
- Pages
- 1039-1052
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC1494957
- OpenAlex
- W2000702318
- Cited by
- 178
- References
- 65
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 3 · 2023: 3 · 2022: 3 · 2021: 5 · 2020: 14 · 2019: 6 · 2018: 3 · 2017: 6 · 2016: 8 · 2015: 10 · 2014: 10 · 2013: 13 · 2012: 15
- FWCI
- 1.51
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Journal of General Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- coronary artery disease, Framingham risk equation, cardiovascular risk prediction, risk calculator, risk charts, primary prevention, clinical feasibility, personal digital assistants, risk factor assessment
- MeSH terms
- Coronary Disease, Humans, Predictive Value of Tests, Risk Factors, MEDLINE, Risk Assessment, Internet
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