Adding socioeconomic status to Framingham scoring might also improve stroke risk evaluation in young adults with hypertension

The recognition that the Framingham Risk Scoring needs to be complemented by evaluation of socioeconomic status for better prediction of coronary heart disease1 has, as its corollary, the acknowledgment that approximately one third of cardiovascular events are not readily attributed to traditional risk factors such as hypertension, hyperlipidemia, diabetes mellitus, smoking, obesity, and sedentary lifestyle.2 In the light of significantly (P < .0001) higher prevalence of hypertension-related stroke in American blacks aged 25 to 49 than in American counterparts of either Hispanic or white ethnicity,3 socioeconomic status, which received only passing comment in the latter study3 and no comment at all in a Finnish study of stroke patients aged 15 to 49, 39% of whom had hypertension,4 incorporation of socioeconomic status, along with newer modalities such as carotid intima-media thickness,5 might enhance the predictive accuracy of the Framingham Risk Scoring for hypertension-related stroke risk in young adults and might also mitigate any potential discrepancy between predicted and observed stroke events.