CoChat
Sign Up
Cited by 47Cardiac Imaging and DiagnosticsCoronary Interventions and DiagnosticsHealth Promotion and Cardiovascular Prevention

Coronary age as a risk factor in the modified Framingham risk score

Open access
Schisterman, Enrique F, Whitcomb, Brian W·2004·BMC Medical Imaging
DOI 10.1186/1471-2342-4-1PMC PMC415549
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: Clinical guidelines emphasize risk assessment as vital to patient selection for medical primary intervention. However, risk assessment methods are restricted in their ability to predict further coronary events. The most widely accepted tool in the United States is the Framingham risk score. In these equations age is a powerful risk factor. Although the extent of coronary atherosclerosis increases with age, there is large inter-individual variability in the rate of development and progression of this disease. This fact limits the utility of Framingham scoring when applied to individuals. Electron beam tomography (EBT), which measures coronary calcium, provides a non-invasive method for assessing coronary plaque burden, thus offering the possibility of providing a more accurate estimate of an individual's "arterial age" than from chronological age alone. METHODS: In this paper we discuss a new and simple method for incorporating the coronary calcium score (CCS) to modify the Framingham Risk Assessment (FRA). Using this method, a coronary artery calcium (CAC) age equivalent is generated that replaces chronological age in Framingham scoring. RESULTS AND DISCUSSION: Using a percentile table of CCS scores by age group and sex, individuals are matched to the age group whose calcium score most closely approximates their own individual score. The original 10-year absolute risk score of a 65-year old man with a CCS of 6 based on chronological age is 10%, whereas the modified absolute risk score based on CAC age equivalents is 2%. CONCLUSION: Our approach of replacing chronological age with CAC age equivalents in the Framingham equations possesses simplicity of application combined with precision. Physicians can easily derive adjusted Framingham risk scores and prescribe intervention methods based on patients' ten-year risks. The adjusted ten-year risks are likely to be more accurate than unadjusted risks since they are based on coronary calcium score information. The modified FRA approach not only may increase the predicted risk for some patients, but also may decrease the predicted risk for others, making it a more precise adjustment than other methods.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1186/1471-2342-4-1

Cites

32 of 32 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Investment in additional measurements such as CT coronary calcium may be helpful but adds cost and time, and its benefit remains unproven.

    “Investment in additional measurements such as imaging with computed tomography to obtain coronary calcium scores may be helpful, 79 but adds considerably to the cost and time involved in risk factor scoring, and its benefit remains unproven.80”

    From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [79]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

1 of the 33 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Schisterman, E. F., & Whitcomb, B. W.
Affiliations
  • National Institutes of Health (US)
  • Cedars-Sinai Medical Center (US)
Corresponding author
Schisterman, Enrique F
ORCID
Venue
BMC Medical Imaging
Publisher
Springer Science and Business Media LLC
Published
2004-04-26
Volume
4
Issue
1
Pages
1-1
ISSN
1471-2342 (ISSN-L)
DOI
10.1186/1471-2342-4-1
PMC
PMC415549
OpenAlex
W2156909775
Cited by
47
References
33
Citations by year
2025: 2 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 2 · 2020: 2 · 2019: 1 · 2018: 3 · 2017: 2 · 2016: 3 · 2015: 2 · 2013: 1 · 2012: 5
FWCI
2.23
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (unspecified)
Locations
  • BMC Medical Imaging (publishedVersion)
  • PubMed Central (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • ScholarWorks@UMassAmherst (University of Massachusetts Amherst) (submittedVersion)
Topics
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
  • Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
Keywords
coronary artery calcium score, cardiovascular risk assessment, coronary artery disease, coronary plaque burden, electron beam computed tomography, percentile tables, risk prediction

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review