Framingham risk score and prediction of coronary heart disease death in young men

Background

We tested the ability of the Framingham Risk Score (FRS) and the online ATP III risk estimator to estimate risk and to predict 10-year and longer-term coronary heart disease (CHD) death in younger adults (age 18-39 years). Although prediction with individual risk factors has been tested in individuals <30 years, current multivariate risk prediction strategies have not been applied to prediction of clinical CHD in this age range.

Methods

We included 10551 male participants of the CHA study who were aged 18 to 39 years and free of baseline CHD and diabetes at enrollment from 1967 to 1973. Risk of CHD was estimated using both FRS and ATP III online risk estimator for each individual. Men were stratified into deciles according to the magnitude of predicted risk calculated from measured baseline risk factors (CHA-predicted risk). Observed CHD mortality rates for 10, 20, and 30 years of follow-up were compared with estimated risks. Death rates of CHD were low across 30 years of follow-up.

Results

The FRS remained <10% for all deciles of CHA-predicted risk in the 18- to 29-year-old cohort. Framingham-predicted risk reached 12% only in the 30- to 39-year-old cohort in the highest decile of CHA-predicted risk despite substantial risk factor burden.

Conclusions

Neither method classified individuals <30 years as high risk despite substantial risk factor burden. Future clinical guidelines should consider alternative strategies to estimate and communicate risk in populations <30 years.