Cardiovascular Risk Assessment, NHLBI Workshop Summary

Summary of National Heart, Lung, and Blood Institute Workshop on Cardiovascular Risk Assessment

Scott M. Grundy, MD, PhD, Ralph B. D'Agostino, Sr., PhD, Lori Mosca, MD, PhD, MPH, Gregory L. Burke, MD, Peter W. F. Wilson, MD, Daniel J. Rader, MD, James I. Cleeman, MD, Edward J. Roccella, PhD, Jeffrey A. Cutler, MD, Lawrence M. Friedman, MD

From: The Center for Human Nutrition, University of Texas Southwestern Medical Center at Dallas, Dallas , TX (SMG), Framingham Heart Study, Boston University, Boston, MA (RBD, PWFW), Preventive Cardiology, Columbia and Cornell Universities, New York, NY (LM), Wake Forest School of Medicine, Winston-Salem, NC (GLB), Preventive Cardiology and Lipid Research Center, University of Pennsylvania Health System, Philadelphia, PA (DJR), and the Office of Prevention, Education, and Control (JIC, EJR), Division of Epidemiology and Clinical Applications (JAC), and Office of the Director (LAF), National Heart, Lung, and Blood Institute, Bethesda, MD.

Correspondence to:
Jeffrey A. Cutler, M.D.
National Heart, Lung, and Blood Institute
6701 Rockledge Drive, RM 8130
Bethesda, Maryland 20892-7936
Tele: (301) 435-0414
Fax: (301) 480-1773
Email: CUTLERJ@NHLBI.NIH.GOV

Abstract

Background: The National Heart, Lung, and Blood Institute conducted a Workshop in January 1999 to assess the applicability to other U.S. populations of coronary heart disease (CHD) risk prediction algorithms generated from the Framingham Heart Study (FHS). This report presents major findings from the workshop, including consideration of applications of risk assessment in practice.

Methods and Results: Longitudinal cohorts were identified for testing the accuracy of the FHS function. The function--based on age and categories of blood pressure, total cholesterol, HDL cholesterol, smoking and diabetic status--was applied (separately by gender and race) to each of the other cohorts. Accuracy of 5-year predictions of non-fatal myocardial infarction or CHD death were compared to those using functions developed with the study's own data. Other than in the older subjects in one cohort, agreement between FHS-based predictions and observed results for relative risk associated with each risk factor was good, except that hypertension was a somewhat stronger predictor in black subjects, especially women. Discrimination between cases and non-cases based on the FHS function as a whole was also satisfactory, but generally not quite as good as the study's own functions. For three cohorts, the FHS function over-predicted absolute CHD risk and some recalibration of the function would be required for optimal use.

Conclusions: From a quantitative viewpoint, the applicability of the FHS risk algorithm using traditional risk factors appears satisfactory for most populations. The Workshop also identified unresolved issues with regard to 1) further development of risk assessment tools, 2) effects on physician and patient behavior, and 3) the role of global risk assessment in clinical guidelines.

Keywords: coronary disease, epidemiology, prevention, risk factors

The complete article is available as a PDF file [800K]
This is an expanded version of the article first published in Circulation, 2001;104:491-496.